Cranioplasty complications [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Cranioplasty complications ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/16i3X1xKDU1iofMmpECvIQNFpWW8w0Y5BKpnBXGJv1xHLAvwvF/?limit=15&utm_campaign=pubmed-2&fc=20230110024304}}
----

----
Complications include:

a) [[infection]]:≈8% risk

b) hematoma: under the cranioplasty flap (epidural or subdural). Epidural more likely than subdural

c) [[seizure]]s

d) [[brain injury]]

e) [[Autologous bone flap cranioplasty complications]]

f) [[hydrocephalus]]

g) CSF leak

h) [[Temporal hollowing]] 

The risk of complication is increased with bifrontal bone defects.

The [[incidence]] of [[complication]]s after [[cranioplasty]] is high, ranging from 12% to 50%.

The [[complication]] [[rate]] of [[cranioplasty]] is higher than for other elective neurosurgical procedures. Older age, poorer functional situation (worse [[Barthel index]] score) and early surgery (≤85 days) are independent risk factors for complications
((Paredes I, Castaño-León AM, Munarriz PM, Martínez-Perez R, Cepeda S, Sanz R,
Alén JF, Lagares A. Cranioplasty after decompressive craniectomy. A prospective
series analyzing complications and clinical improvement. Neurocirugia (Astur).
2014 Dec 9. pii: S1130-1473(14)00145-6. doi: 10.1016/j.neucir.2014.10.001. [Epub 
ahead of print] PubMed PMID: 25497290.
)).

Cranioplasty after [[decompressive craniectomy]] (DC) is associated with increased morbidity, but the reported mortality rate is low.
----
[[Intracranial pressure]] (ICP) is a crucial factor that we need to take into account in all major pathophysiological changes of the brain after [[decompressive craniectomy]] (DC) and [[cranioplasty]] (CP). The purpose of a study was to check [[ICP]] values before and after cranioplasty and its relation to various parameters (imaging, demographics, time of cranioplasty, and type of graft) as well as its possible relation to postsurgical [[cranioplasty complications]]. The authors performed a [[prospective]] study in which they selected as participants adults who had undergone unilateral frontotemporoparietal DC and were planned to have cranioplasty. Intracranial pressure was measured with [[fiber-optic sensor]] in the [[epidural space]] and did not affect cranioplasty in any way.Twenty-five patients met the criteria. The mean vcICP (value change of ICP) was 1.2 mm Hg, the mean ΔICP (absolute value change of the ICP) was 2.24 mm Hg and in the majority of cases there was an increase in ICP. The authors found 3 statistically significant correlations: between gender and ΔICP, Δtime (time between DC and CP) and vcICP, and pre-ICP and ±ICP (quantitative change of the ICP).Μale patients tend to develop larger changes of ICP values during CP. As the time between the 2 procedures (DC and CP) gets longer, the vcICP is decreased. However, after certain time it shows a tendency to remain around zero. Lower pre-ICP values (close to or below zero) are more possible to increase after bone flap placement. It seems that the brain tends to restore its pre-DC conditions after CP by taking near-to-normal ICP values
((Tsianaka E, Singh A, Drosos E, Fountas K. Direct Consequences of Cranioplasty to the Brain: Intracranial Pressure Study. J Craniofac Surg. 2021 Nov-Dec 01;32(8):2779-2783. doi: 10.1097/SCS.0000000000007945. PMID: 34727479.)).


===== Epidural Fluid Collection =====

[[Epidural Fluid Collection]].

===== Brain herniation =====

The Death from [[brain herniation]] after cranioplasty
((Li J, Lin H, Long X. The Death from cerebral hernia after cranioplasty: A case report. Asian J Surg. 2024 Mar 25:S1015-9584(24)00545-1. doi: 10.1016/j.asjsur.2024.03.115. Epub ahead of print. PMID: 38531742.))
===== Massive cerebral edema =====

[[Brain edema after cranioplasty]].

===== Intracerebral Hemorrhagic Infarction =====

Cranioplasty-related [[reperfusion injury]]
((Oh HJ, Shim JJ, Ahn JM, Oh JS, Yoon SM. Multiple Cerebral Hemorrhages Caused by Paradoxical Reperfusion Injury After Cranioplasty. Korean J Neurotrauma. 2022 May 31;18(2):335-340. doi: 10.13004/kjnt.2022.18.e28. PMID: 36381453; PMCID: PMC9634289.)) 

===== Infection =====

see [[Cranioplasty infection]].

===== Epilepsy after cranioplasty ===== 

see [[Epilepsy after cranioplasty]].

===== Autologous bone flap cranioplasty complications =====

see [[Autologous bone flap cranioplasty complications]].

===== Subdural empyema =====
Male, 47 years old, with a history of [[malignant middle cerebral artery infarction]] with [[decompressive craniectomy]] exactly one year ago and underwent [[cranioplasty]]

Reports experiencing an unusual headache and swelling with increased temperature in the cranioplasty area, along with the discharge of serosanguinous fluid that was not present before.

Physical Examination (EF): Swelling in the cranioplasty area with increased temperature.


An urgent non-contrast and contrast-enhanced cranial CT scan is performed.

{{::captura_de_pantalla_2024-01-18_a_las_19.55.00.jpg?200|}}

REPORT:
Compared to the last study there is a presence of an extra-axial collection on the right convexity underlying the cranioplasty.
It has a subdural morphology, approximately 2.7 cm in the coronal plane, with a heterogeneous content predominantly hyperdense, likely related to hematic residues, as well as some minimal air bubbles. There is a striking enhancement of the dura mater, and radiological signs suggestive of [[subdural empyema]]. This collection causes a mass effect on the underlying cerebral sulci but does not cause midline deviation or clear signs of [[herniation]].

A discrete increase in extracranial soft tissues of about 2 cm thickness in the coronal plane adjacent to the cranioplasty is also identified. It shows heterogeneous contrast enhancement and ill-defined hypodense foci inside, suggesting soft tissue infection with associated myositis and subgaleal collections.

There are no signs of bone resorption of the cranioplasty suggesting associated osteomyelitis.

Extensive corticosubcortical hypodensity in the territory of the right middle cerebral artery is identified, indicating an old ischemic infarction. This results in slight retraction of the right occipital and temporal horns, as well as slight hypodensity of the right mesencephalic peduncle related to Wallerian degeneration.




===== Case series =====

[[Cranioplasty complications case series]].