Risk factors and rates of bone flap resorption in pediatric patients after decompressive craniectomy for traumatic brain injury

2013 ◽  
Vol 11 (5) ◽  
pp. 526-532 ◽  
Author(s):  
Christian A. Bowers ◽  
Jay Riva-Cambrin ◽  
Dean A. Hertzler ◽  
Marion L. Walker
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Multivariate Analysis ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Pediatric Patients ◽  
Skull Fracture ◽  
Bone Flap ◽  
Bone Flap Resorption ◽  
Independent Risk Factors

Object Decompressive craniectomy with subsequent autologous cranioplasty, or the replacement of the native bone flap, is often used for pediatric patients with traumatic brain injury (TBI) who have a mass lesion and intractable intracranial hypertension. Bone flap resorption is common after bone flap replacement, necessitating additional surgery. The authors reviewed their large database of pediatric patients with TBI who underwent decompressive craniectomy followed by bone flap replacement to determine the rate of bone flap resorption and identify associated risk factors. Methods A retrospective cohort chart review was performed to identify long-term survivors who underwent decompressive craniectomy for severe TBI with bone flap replacement from January 1, 1996, to December 31, 2011. The risk factors investigated in a univariate statistical analysis were age, sex, underlying parenchymal contusion, Glasgow Coma Scale score on arrival, comminuted skull fracture, posttraumatic hydrocephalus, bone flap wound infection, and freezer time (the amount of time the bone flap was stored in the freezer before replacement). A multivariate logistic regression model was then used to determine which of these were independent risk factors for bone flap resorption. Results Bone flap replacement was performed at an average of 2.1 months after decompressive craniectomy. Of the 54 patients identified (35 boys, 19 girls; mean age 6.2 years), 27 (50.0%) experienced bone flap resorption after an average of 4.8 months. Underlying parenchymal contusion, comminuted skull fracture, age ≤ 2.5 years, and posttraumatic hydrocephalus were significant, or nearly significant, on univariate analysis. Multivariate analysis identified underlying contusion (p = 0.004, OR 34.4, 95% CI 3.0–392.7), comminuted skull fractures (p = 0.046, OR 8.5, 95% CI 1.0–69.6), posttraumatic hydrocephalus (p = 0.005, OR 35.9, 95% CI 2.9–436.6), and age ≤ 2.5 years old (p = 0.01, OR 23.1, 95% CI 2.1–257.7) as independent risk factors for bone flap resorption. Conclusions After decompressive craniectomy for pediatric TBI, half of the patients (50%) who underwent bone flap replacement experienced resorption. Multivariate analysis indicated young age (≤ 2.5 years), hydrocephalus, underlying contusion as opposed to a hemispheric acute subdural hematoma, and a comminuted skull fracture were all independent risk factors for bone flap resorption. Freezer time was not found to be associated with bone flap resorption.

scholarly journals Initial Dead Space and Multiplicity of Bone Flap as Strong Risk Factors for Bone Flap Resorption after Cranioplasty for Traumatic Brain Injury

2018 ◽  
Vol 14 (2) ◽  
pp. 105 ◽  
Author(s):  
Jeong Kyun Joo ◽  
Jong-Il Choi ◽  
Chang Hyun Kim ◽  
Ho Kook Lee ◽  
Jae Gon Moon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Dead Space ◽  
Bone Flap ◽  
Bone Flap Resorption

Predicting Outcome and Conservative Treatment Failure in Patients with Skull Fracture after Traumatic Brain Injury: A Retrospective Cohort Study

2019 ◽  
Vol 80 (06) ◽  
pp. 460-469
Author(s):  
Ernest J. Bobeff ◽  
Bartłomiej J. Posmyk ◽  
Katarzyna Ł. Bobeff ◽  
Jan Fortuniak ◽  
Karol Wiśniewski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Conservative Treatment ◽  
Treatment Failure ◽  
Epidural Hematoma ◽  
Skull Fracture ◽  
Mass Effect ◽  
Independent Risk Factors ◽  
Neurosurgical Intervention

Abstract Objective Traumatic brain injury (TBI) remains a major cause of morbidity and mortality worldwide. The prognostic value of skull fracture (SF) remains to be clearly defined. To evaluate the need for neurosurgical intervention and determine the risk factors of conservative treatment failure (CTF), we retrieved from the hospital database the records of patients with SF after TBI. Methods We analyzed 146 consecutive patients (mean age: 49.8 ± 17.5 years) treated at the department of neurosurgery in a 5-year period. Clinical data, radiologic reports, and laboratory results were evaluated retrospectively. Results A total of 63% of patients were treated conservatively, 21.9% were operated on immediately, and 15.1% experienced CTF. Overall, 73.3% had a favorable outcome; the mortality rate was 13%. Intracranial bleeding occurred in 96.6% of cases, basilar SF in 61%, and cerebrospinal fluid (CSF) leak in 2.8%. The independent risk factors for outcome were Glasgow Coma Scale (GCS) score, age, and platelet count (PCT). The independent risk factors for CTF were epidural hematoma, subdural hematoma, mass effect, edema, international normalized ratio, PCT, mean platelet volume, and CSF leakage. The consensus decision tree algorithm used at the accident and emergency department indicated patients with no need for neurosurgical intervention with an accuracy of 91.7%, sensitivity of 88.9%, and featured the importance of mass effect, GCS, and epidural hematoma. Conclusions Tests included in the complete blood count appeared useful for predicting the course in patients with SF, although the most important factors were age and neurologic status, as well as radiologic findings. Our decision tree requires further validation before it can be used in everyday practice.

scholarly journals Bone Flap Resorption in Pediatric Patients Following Autologous Cranioplasty

2021 ◽  
Author(s):  
David S Hersh ◽  
Hanna J Anderson ◽  
Graeme F Woodworth ◽  
Jonathan E Martin ◽  
Yusuf M Khan
Keyword(s):  
Risk Factors ◽  
Bone Resorption ◽  
Decompressive Craniectomy ◽  
Pediatric Patients ◽  
Bone Flap ◽  
Calvarial Bone ◽  
Advantages And Disadvantages ◽  
Bone Flap Resorption ◽  
Autologous Bone

Abstract Following a decompressive craniectomy, the autologous bone flap is generally considered the reconstructive material of choice in pediatric patients. Replacement of the original bone flap takes advantage of its natural biocompatibility and the associated low risk of rejection, as well as the potential to reintegrate with the adjacent bone and subsequently grow with the patient. However, despite these advantages and unlike adult patients, the replaced calvarial bone is more likely to undergo delayed bone resorption in pediatric patients, ultimately requiring revision surgery. In this review, we describe the materials that are currently available for pediatric cranioplasty, the advantages and disadvantages of autologous calvarial replacement, the incidence and classification of bone resorption, and the clinical risk factors for bone flap resorption that have been identified to date.

Risk Factors and Neurologic Outcomes in Patients With Traumatic Brain Injury and Coagulopathy Within 72 Hours Post-operatively

2021 ◽  
Author(s):  
Tao Chang ◽  
Xigang Yan ◽  
Chao Zhao ◽  
Yufu Zhang ◽  
Bao Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Logistic Regression ◽  
Brain Injury ◽  
Multivariate Logistic Regression ◽  
Neurologic Outcomes ◽  
Post Operative Period ◽  
Duration Of Surgery ◽  
Independent Risk Factors ◽  
Time Of Admission

Abstract Background There are few studies on the development and effect of coagulopathy in patients with a traumatic brain injury (TBI) during the early post-operative period. We determined the risk factors and neurologic outcomes of in patients with a TBI and coagulopathy diagnosed by routine laboratory tests within 72 hours post-operatively. Methods The baseline characteristics, intra-operative management, and follow-up results of 462 patients with TBIs were obtained and retrospectively analyzed by multivariate logistic regression from January 2015 to June 2019. Coagulopathy was defined as an activated partial thromboplastin time > 40 seconds, international normalized ratio >1.4, or a platelet count < 100×109 /L.Results Multivariate logistic regression analysis revealed that the Glasgow Coma Scale (GCS) at the time of admission, Injury Severity Score (ISS) at the time of admission, pupil mydriasis, duration of surgery, intra-operative blood loss, and intra-operative crystalloid resuscitation were independent risk factors for patients who developed a coagulopathy post-operatively. There were statistical differences in mortality (p = 0.049), the Glasgow Outcome Scale-Extended (GCS-E; p = 0.024), and the modified Rankin Scale (p = 0.043) between patients with and without coagulopathy 1 week after surgery. Coagulopathy within 72 h after surgery revealed a trend for higher mortality at 1 week (66.7%), 3 months (71.4%), and 6 months (76.2%). Furthermore, coagulopathy and contusion expansion in the early post-operative period were independent risk factors for TBI mortality after surgery. Intra-operative crystalloid resuscitation had a substantial diagnostic accuracy in predicting coagulopathy within 72 h post-operatively (area under the curve [AUC] = 0.972).Conclusion Coagulopathy within 72 h post-operatively in patients with a TBI predicted worse disease progression and unfavorable neurologic outcomes. Hence, we should take practical and reasonable measures to manage these risk factors, which may protect patients with a TBI from post-operative coagulopathy.

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