Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures

2014 ◽  
Vol 121 (2) ◽  
pp. 313-318 ◽  
Author(s):  
Juneyoung Heo ◽  
Sukh Que Park ◽  
Sung Jin Cho ◽  
Jae Chil Chang ◽  
Hyung-ki Park
Keyword(s):  
Decompressive Craniectomy ◽  
Fluid Collection ◽  
Patient Characteristics ◽  
Defect Size ◽  
Complication Rates ◽  
Subdural Fluid Collection ◽  
Brain Swelling ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Cranial Defect

Object Some patients with severe brain swelling treated with decompressive craniectomy may develop hydrocephalus. Consequently, these patients require cranioplasty and a ventriculoperitoneal (VP) shunt to relieve the hydrocephalus. However, there is no consensus as to the timing of the cranioplasty and VP shunt placement in patients requiring both. The authors assessed the results of performing cranioplasty and VP shunt placement at the same time in patients with cranial defects and hydrocephalus. Methods A retrospective review was performed of 51 patients who had undergone cranioplasty and VP shunt operations after decompressive craniectomy for refractory intracranial hypertension between 2003 and 2012 at the authors' institution. Patient characteristics, data on whether the operations were performed simultaneously, brain bulging, hydrocephalus, cranial defect size, and complications were analyzed. Results The overall complication rate was 43% (22 of 51 patients). In 32 cases, cranioplasty and VP shunt placement were performed at the same time. Complications included subdural hematoma, subdural fluid collection, and infection. The group undergoing cranioplasty and VP shunt placement at the same time had higher complication rates than the group undergoing the procedures at different times (56% vs 21%, respectively). The severity of complications was also greater in the former group. Patients with severe brain bulging had higher complication rates than did those without brain bulging (51% vs 0%, respectively). Cranial defect size, severity of hydrocephalus, indication for decompressive craniectomy, age, sex, and interval between decompressive craniectomy and subsequent operation did not affect complication rates. Conclusions Patients undergoing cranioplasty and VP shunt placement at the same time had higher complication rates, especially those with severe brain bulging.

External hydrocephalus after aneurysm surgery: paradoxical response to ventricular shunting

1998 ◽  
Vol 88 (3) ◽  
pp. 485-489 ◽  
Author(s):  
Yuhei Yoshimoto ◽  
Susumu Wakai ◽  
Masaaki Hamano
Keyword(s):  
Aneurysmal Subarachnoid Hemorrhage ◽  
Fluid Collection ◽  
Young Patients ◽  
Subdural Fluid Collection ◽  
Subdural Hygroma ◽  
Content Type ◽  
Vp Shunt ◽  
External Hydrocephalus ◽  
Shunt Placement ◽  
Fine Print

Object. The authors sought to investigate the mechanisms and pathophysiological effects of subdural fluid collection after surgery for aneurysmal subarachnoid hemorrhage (SAH). Methods. The authors retrospectively analyzed the medical records of 76 patients who had undergone craniotomy. The patients included 55 with aneurysmal SAH (SAH group) and 21 with unruptured aneurysms (non-SAH group) who were used as controls. Subdural fluid collection was more common in the SAH than in the non-SAH group (38% compared with 14%, p < 0.05). Although older patients appeared to be at greater risk for subdural fluid collection in both groups (p < 0.05), this condition developed even in relatively young patients with SAH. In the SAH group most subdural fluid collection was associated with ventricular dilation (81%), and a significant correlation was seen between fluid collection and the need for subsequent shunt placement (48% compared with 21%, p < 0.05). These results point to an association between hydrodynamic dysfunction and subdural fluid collection. The course of patients with subdural fluid collection varied from spontaneous resolution to normal-pressure hydrocephalus. Seven patients with persistent subdural collections underwent shunt placement (ventriculoperitoneal [VP] shunt in six and lumboperitoneal in one), which resulted in resolution of fluid collection in all seven. Conclusions. The results indicate that for most patients in the SAH group, subdural fluid collection represented “external hydrocephalus” rather than simple “subdural hygroma.” Decreased absorption of cerebrospinal fluid because of SAH and surgically created tears in the arachnoid membrane communicating with the subdural space were factors in the development of external hydrocephalus. The authors believe that differentiating external hydrocephalus from subdural hygroma is extremely important, because VP shunt placement can be used to treat the former but could worsen the latter.

scholarly journals Low-dose acetylsalicylic acid and bleeding risks with ventriculoperitoneal shunt placement

2016 ◽  
Vol 41 (3) ◽  
pp. E4 ◽  
Author(s):  
Maria Kamenova ◽  
Davide Croci ◽  
Raphael Guzman ◽  
Luigi Mariani ◽  
Jehuda Soleman
Keyword(s):  
Acetylsalicylic Acid ◽  
Antiplatelet Therapy ◽  
Low Dose ◽  
Perioperative Management ◽  
Morbidity And Mortality ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Bleeding Events ◽  
Vp Shunt ◽  
Shunt Placement

OBJECTIVE Ventriculoperitoneal (VP) shunt placement is a common procedure for the treatment of hydrocephalus following diverse neurosurgical conditions. Most of the patients present with other comorbidities and receive antiplatelet therapy, usually acetylsalicylic acid (ASA). Despite its clinical relevance, the perioperative management of these patients has not been sufficiently investigated. The aim of this study was to compare the peri- and postoperative bleeding complication rates associated with ASA intake in patients undergoing VP shunt placement. METHODS Of 172 consecutive patients undergoing VP shunt placement between June 2009 and December 2015, 40 (23.3%) patients were receiving low-dose ASA treatment. The primary outcome measure was bleeding events in ASA users versus nonusers, whereas secondary outcome measures were postoperative cardiovascular events, hematological findings, morbidity, and mortality. A subgroup analysis was conducted in patients who discontinued ASA treatment for < 7 days (n = 4, ASA Group 1) and for ≥ 7 days (n = 36, ASA Group 2). RESULTS No statistically significant difference for bleeding events was observed between ASA users and nonusers (p = 0.30). Cardiovascular complications, surgical morbidity, and mortality did not differ significantly between the groups either. Moreover, there was no association between ASA discontinuation regimens (< 7 days and ≥ 7 days) and hemorrhagic events. CONCLUSIONS Given the lack of guidelines regarding perioperative management of neurosurgical patients with antiplatelet therapy, these findings elucidate one issue, showing comparable bleeding rates in ASA users and nonusers undergoing VP shunt placement.

Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

2013 ◽  
Vol 12 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Brandon G. Rocque ◽  
Kaushik Amancherla ◽  
Sean M. Lew ◽  
Sandi Lam
Keyword(s):  
Bone Resorption ◽  
Decompressive Craniectomy ◽  
Complication Rate ◽  
Case Reports ◽  
Pediatric Population ◽  
Defect Size ◽  
Complication Rates ◽  
Appreciable Effect ◽  
Pooled Data ◽  
Early Cranioplasty

Cranioplasty is routinely performed following decompressive craniectomy in both adult and pediatric populations. In adults, this procedure is associated with higher rates of complications than is elective cranial surgery. This study is a review of the literature describing risk factors for complications after cranioplasty surgery in pediatric patients. A systematic search of PubMed, Cochrane, and SCOPUS databases was undertaken. Articles were selected based on their titles and abstracts. Only studies that focused on a pediatric population were included; case reports were excluded. Studies in which the authors assessed bone flap storage method, timing of cranioplasty, material used (synthetic vs autogenous), skull defect size, and/or complication rates (bone resorption and surgical site infection) were selected for further analysis. Eleven studies that included a total of 441 cranioplasties performed in the pediatric population are included in this review. The findings are as follows: 1) Based on analysis of pooled data, using cryopreserved bone flaps during cranioplasty may lead to a higher rate of bone resorption and lower rate of infection than using bone flaps stored at room temperature. 2) In 3 of 4 articles describing the effect of time between craniectomy and cranioplasty on complication rate, the authors found no significant effect, while in 1 the authors found that the incidence of bone resorption was significantly lower in children who had undergone early cranioplasty. Pooling of data was not possible for this analysis. 3) There are insufficient data to assess the effect of cranioplasty material on complication rate when considering only cranioplasties performed to repair decompressive craniectomy defects. However, when considering cranioplasties performed for any indication, those in which freshly harvested autograft is used may have a lower rate of resorption than those in which stored autograft is used. 4) There is no appreciable effect of craniectomy defect size or patient age on complication rate. There is a paucity of articles describing outcomes and complications following cranioplasty in children and adolescents. However, based on the studies examined in this systematic review, there are reasons to suspect that method of flap preservation, timing of surgery, and material used may be significant. Larger prospective and retrospective studies are needed to shed more light on this important issue.

scholarly journals Sinking Skin Flap Syndrome following Posttraumatic Hydrocephalus

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ashish Chugh ◽  
Prashant Punia ◽  
Sarang Gotecha
Keyword(s):  
Decompressive Craniectomy ◽  
Postoperative Period ◽  
Skin Flap ◽  
Case Series ◽  
Bone Flap ◽  
Complication Rates ◽  
Review Of Literature ◽  
Trendelenburg Position ◽  
Vp Shunt ◽  
Shunt Occlusion

Introduction. Complications following craniotomy are not uncommon and Sinking Skin Flap Syndrome (SSFS) constitutes a rare entity that may present after a large Decompressive Craniectomy. Although the entity is widely reported, the literature mostly consists of case reports. Authors present a case series of three patients with review of literature highlighting the various factors which can prove therapeutic and can help in avoidance of complications. Materials and Methods. The study was conducted over a period of 3 years, from 2016 to 2019, and included 212 patients who underwent unilateral Decompressive Craniectomy (DC) for trauma in our institute. All 212 patients underwent a similar DC following a strict institutional protocol and the craniectomies were performed by the same surgical team. At total of 160 patients survived and elective cranioplasty was planned at a 3-month interval. Out of a total of 160 patients who survived, 38 developed hydrocephalus, 3 patients presented with hydrocephalus acutely and had to be shunted before cranioplasty and underwent ventriculoperitoneal (VP) shunting on the opposite side of craniectomy. All 3 of these patients developed SSFS and were the focus of this case series wherein review of literature was done with emphasis being laid on the salient features towards management of SSFS in such precranioplasty shunted patients. These 3 patients were treated via rehydration using normal saline (NS) till the Central Venous Pressure (CVP) equaled 8–10 cm of water, nursing in Trendelenburg position and shunt occlusion using silk 3-0 round bodied suture tied over a “C”-loop of VP shunt tube over clavicle. This was followed by cranioplasty within 2 days of presentation using a flattened, nonconvex artificial Polymethyl Methacrylate (PMMA) bone flap with central hitch suture taken across the bone flap and release of shunt tie in immediate postoperative period. The PMMA bone flap was made intraoperatively after measuring the defect size accurately after exposure of defect. 3D printing option was not availed by any patient considering the high cost and patients’ poor socioeconomic status. Results. Out of a total of 212 patients, thirty-eight patients (19%) developed posttraumatic hydrocephalus and out of 38, three presented with SSFS over the course of time. Two patients presented with hemiparesis of the side opposite to sunken flap while 1 other patient was brought by relatives in stuporous state. All 3 were subjected to VP shunt tie, rehydration, and cranioplasty using flattened artificial bone flap and showed gradual recovery in postoperative period without any complications. Conclusion. Various factors like nursing in Trendelenburg position, adequate rehydration, early cranioplasty after resolution of oedema, preoperative tying of VP shunt and its subsequent release in immediate postoperative period, use of flattened PMMA bone flaps, placement of a central dural hitch suture across the bone, and a preoperative central burr hole in the bone flap may accelerate healing and, in most cases, reversal of sensory-motor deficits along with reduction in complication rates.

Prevention of subdural fluid collections following transcortical intraventricular and/or paraventricular procedures by using fibrin adhesive

2000 ◽  
Vol 92 (3) ◽  
pp. 406-412 ◽  
Author(s):  
Mahmoud Al-Yamany ◽  
Rolando F. Del Maestro
Keyword(s):  
Fluid Collection ◽  
Seizure Disorder ◽  
Neurosurgical Procedures ◽  
Subdural Fluid Collection ◽  
Fibrin Adhesive ◽  
Content Type ◽  
Shunt Placement ◽  
Fluid Collections ◽  
Fine Print

Object. Subdural fluid collections following transcortical intraventricular and/or paraventricular neurosurgical procedures for tumors are common and can be difficult to treat. The authors prospectively studied the efficacy of a fibrin adhesive (Tisseel) in closing cortical and ependymal defects following intraventricular and/or paraventricular lesion resection and in preventing the development of subdural fluid collections.Methods. Twenty-five patients who underwent 29 transcortical approaches for the resection of intraventricular and/or paraventricular lesions were studied. No patient developed a symptomatic subdural fluid collection and no new seizure or progression of a preexisting seizure disorder was encountered during a median follow-up time of 29 months (range 1–57 months). The incidence of preoperative hydrocephalus was 72% and four (22%) of these patients required postoperative shunt placement.Conclusions. The use of a fibrin adhesive to seal cortical and ependymal defects after transcortical procedures appears to prevent the development of subdural fluid collections.

scholarly journals Cranioplasty following ventriculoperitoneal shunting: lessons learned

2020 ◽  
Author(s):  
Dorian Hirschmann ◽  
Beate Kranawetter ◽  
Constanze Kirchschlager ◽  
Matthias Tomschik ◽  
Jonathan Wais ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Graft ◽  
Fluid Collection ◽  
Graft Infection ◽  
Lessons Learned ◽  
Consecutive Series ◽  
Complication Rates ◽  
Subdural Fluid Collection ◽  
Ventriculoperitoneal Shunting ◽  
Chi Squared

Abstract Objective Cranioplasty (CP) is considered as a straightforward and technically unchallenging operation; however, complication rates are high reaching up to 56%. Presence of a ventriculoperitoneal shunt (VPS) and timing of CP are reported risk factors for complications. Pressure gradients and scarring at the site of the cranial defect seem to be critical in this context. The authors present their experiences and lessons learned. Methods A consecutive series of all patients who underwent CP at the authors’ institution between 2002 and 2017 were included in this retrospective analysis. Complications were defined as all events that required reoperation. Logistic regression analysis and chi-squared test were conducted to evaluate the complication rates according to suspected risk factors. Results A total of 302 patients underwent cranioplasty between 2002 and 2017. The overall complication rate was 17.5%. Complications included epi-/subdural fluid collection (7.3%) including hemorrhage (4.6%) and hygroma (2.6%), bone graft resorption (5.3%), bone graft infection (2.0%), and hydrocephalus (5.7%). Overall, 57 patients (18.9%) had undergone shunt implantation prior to CP. The incidence of epi-/subdural fluid collection was 19.3% in patients with VPS and 4.5% in patients without VPS, OR 5.1 (95% CI 2.1–12.4). Incidence of hygroma was higher in patients who underwent early CP. Patients with temporary shunt ligation for CP did not suffer from complications. Conclusion CP in patients with a VPS remains a high-risk procedure. Any effort to understand the pressure dynamics and to reduce factors that may trigger the formation of a large epidural space must be undertaken.

Clinical outcomes of normal pressure hydrocephalus in 116 patients: objective versus subjective assessment

2020 ◽  
Vol 132 (6) ◽  
pp. 1757-1763 ◽  
Author(s):  
Eva M. Wu ◽  
Tarek Y. El Ahmadieh ◽  
Benjamin Kafka ◽  
James P. Caruso ◽  
Om J. Neeley ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Clinical Characteristics ◽  
Objective Assessment ◽  
Normal Pressure ◽  
Subjective Assessment ◽  
Complication Rates ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Significant Difference ◽  
Shunt Response

OBJECTIVEObjective assessment tests are commonly used to predict the response to ventriculoperitoneal (VP) shunting in patients with normal pressure hydrocephalus (NPH). Whether subjective reports of improvement after a lumbar drain (LD) trial can predict response to VP shunting remains controversial. The goal in this study was to compare clinical characteristics, complication rates, and shunt outcomes of objective and subjective LD responders who underwent VP shunt placement.METHODSThis was a retrospective review of patients with NPH who underwent VP shunt placement after clinical improvement with the LD trial. Patients who responded after the LD trial were subclassified into objective LD responders and subjective LD responders. Clinical characteristics, complication rates, and shunt outcomes between the 2 groups were compared with chi-square test of independence and t-test.RESULTSA total of 116 patients received a VP shunt; 75 were objective LD responders and 41 were subjective LD responders. There was no statistically significant difference in patient characteristics between the 2 groups, except for a shorter length of stay after LD trial seen with subjective responders. The complication rates after LD trial and VP shunting were not significantly different between the 2 groups. Similarly, there was no significant difference in shunt response between objective and subjective LD responders. The mean duration of follow-up was 1.73 years.CONCLUSIONSReports of subjective improvement after LD trial in patients with NPH can be a reliable predictor of shunt response. The currently used objective assessment scales may not be sensitive enough to detect subtle changes in symptomatology after LD trial.

scholarly journals Clinical Efficacy and Safety of Silicone Elastomer Sheet during Decompressive Craniectomy: Anti-Adhesive Role in Cranioplasty

2021 ◽  
Vol 11 (1) ◽  
pp. 124
Author(s):  
Young Ha Kim ◽  
Chi Hyung Lee ◽  
Chang Hyeun Kim ◽  
Dong Wuk Son ◽  
Sang Weon Lee ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Fluid Collection ◽  
Multivariate Logistic Regression Analysis ◽  
Operation Time ◽  
Silicone Elastomer ◽  
Control Group ◽  
Estimated Blood Loss ◽  
Adhesion Tissue ◽  
Skull Bone Defect ◽  
Epidural Adhesion

(1) Background: Cranioplasty is a surgery to repair a skull bone defect after decompressive craniectomy (DC). If the process of dissection of the epidural adhesion tissue is not performed properly, it can cause many complications. We reviewed the effect of a silicone elastomer sheet designed to prevent adhesion. (2) Methods: We retrospectively reviewed 81 consecutive patients who underwent DC and subsequent cranioplasty at our institution between January 2015 and December 2019. We then divided the patients into two groups, one not using the silicone elastomer sheet (n = 50) and the other using the silicone elastomer sheet (n = 31), and compared the surgical outcomes. (3) Results: We found that the use of the sheet shortened the operation time by 24% and reduced the estimated blood loss (EBL) by 43% compared to the control group. Moreover, the complication rate of epidural fluid collection (EFC) in the group using the sheet was 16.7%, which was lower than that in the control group (41.7%, p < 0.023). Multivariate logistic regression analysis showed the sheet (OR 0.294, 95% CI 0.093–0.934, p = 0.039) to be significantly related to EFC. (4) Conclusions: The technique using the silicone elastomer sheet allows surgeons to easily dissect the surgical plane during cranioplasty, which shortens the operation time, reduces EBL, and minimizes complications of EFC.

Complications Following Decompressive Craniectomy

2021 ◽  
Author(s):  
Jan Mraček ◽  
Jan Mork ◽  
Jiri Dostal ◽  
Radek Tupy ◽  
Jolana Mrackova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Decompressive Craniectomy ◽  
Clinical Status ◽  
Fluid Collection ◽  
Epileptic Seizures ◽  
Middle Cerebral Artery Infarction ◽  
Temporal Muscle ◽  
Life Saving ◽  
Potential Risk Factors ◽  
The Impact

Abstract Background Decompressive craniectomy (DC) has become the definitive surgical procedure to manage a medically intractable rise in intracranial pressure. DC is a life-saving procedure resulting in lower mortality but also higher rates of severe disability. Although technically straightforward, DC is accompanied by many complications. It has been reported that complications are associated with worse outcome. We reviewed a series of patients who underwent DC at our department to establish the incidence and types of complications. Methods We retrospectively evaluated the incidence of complications after DC performed in 135 patients during the time period from January 2013 to December 2018. Postoperative complications were evaluated using clinical status and CT during 6 months of follow-up. In addition, the impact of potential risk factors on the incidence of complications and the impact of complications on outcome were assessed. Results DC was performed in 135 patients, 93 of these for trauma, 22 for subarachnoid hemorrhage, 13 for malignant middle cerebral artery infarction, and 7 for intracerebral hemorrhage. Primary DC was performed in 120 patients and secondary DC in 15 patients. At least 1 complication occurred in each of 100 patients (74%), of which 22 patients (22%) were treated surgically. The following complications were found: edema or hematoma of the temporal muscle (34 times), extracerebral hematoma (33 times), extra-axial fluid collection (31 times), hemorrhagic progression of contusions (19 times), hydrocephalus (12 times), intraoperative malignant brain edema (10 times), temporal muscle atrophy (7 times), significant intraoperative blood loss (6 times), epileptic seizures (5 times), and skin necrosis (4 times). Trauma (p = 0.0006), coagulopathy (p = 0.0099), and primary DC (p = 0.0252) were identified as risk factors for complications. There was no significant impact of complications on outcome. Conclusions The incidence of complications following DC is high. However, we did not confirm a significant impact of complications on outcome. We emphasize that some phenomena are so frequent that they can be considered a consequence of primary injury or natural sequelae of the DC rather than its direct complication.

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