scholarly journals Bone flap management in neurosurgery

2019 ◽  
Vol 17 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Andrei Fernandes Joaquim ◽  
João Paulo Mattos ◽  
Feres Chaddad Neto ◽  
Armando Lopes ◽  
Evandro de Oliveira
Keyword(s):  
Bone Flap ◽  
Flap Management

A remoção cirúrgica do flap ósseo em casos de craniotomia descompressiva vem sendo cada vez mais usada para o tratamento de swelling pós-traumático, doenças cerebrovasculares ou no edema cerebral pós cirurgia eletiva não responsivo ao tratamento clínico. O destino do retalho ósseo até ao seu uso para cranioplastia em tempo oportuno é motivo de controvérsia e diferentes condutas são adotadas em centros de todo o mundo. Abordamos e discutimos nesta revisão os diferentes locais de preservação do retalho ósseo (subgaleal, parede abdominal e congelamento), quando desprezá-lo e o que fazer frente à contaminação durante o ato operatório ou se infectado.

scholarly journals Bone flap management strategies for postcraniotomy surgical site infection

2021 ◽  
Vol 12 ◽  
pp. 341
Author(s):  
Colin Gold ◽  
Ioannis Kournoutas ◽  
Scott C. Seaman ◽  
Jeremy Greenlee
Keyword(s):  
Surgical Site Infection ◽  
Retrospective Chart Review ◽  
Bone Flap ◽  
Site Infection ◽  
Wound Debridement ◽  
Wound Breakdown ◽  
Significant Difference ◽  
Titanium Cranioplasty ◽  
Flap Management ◽  
Infection Recurrence

Background: Surgical site infection (SSI) after a craniotomy is traditionally treated with wound debridement and disposal of the bone flap, followed by intravenous antibiotics. The goal of this study is to evaluate the safety of replacing the bone flap or performing immediate titanium cranioplasty. Methods: All craniotomies at single center between 2008 and 2020 were examined to identify 35 patients with postoperative SSI. Patients were grouped by bone flap management: craniectomy (22 patients), bone flap replacement (seven patients), and titanium cranioplasty (six patients). Retrospective chart review was performed to identify patient age, gender, index surgery indication and duration, diffusion restriction on MRI, presence of gross purulence, bacteria cultured, sinus involvement, implants used during surgery, and antibiotic prophylaxis/ treatment. These variables were compared to future infection recurrence and wound breakdown. Results: There was no significant difference in infection recurrence or future wound breakdown among the three bone flap management groups (P = 0.21, P = 0.25). None of the variables investigated had any significant relation to infection recurrence when all patients were included in the analysis. However, when only the bone flap replacement group was analyzed, there was significantly higher infection recurrence when there was frank purulence present (P = 0.048). Conclusion: Replacing the bone flap or performing an immediate titanium cranioplasty is safe alternatives to discarding the bone flap after postoperative craniotomy SSI. When there is gross purulence present, caution should be used in replacing the bone flap, as infection recurrence is significantly higher in this subgroup of patients.

When the Bone Flap Hits the Floor

2008 ◽  
Vol 2008 ◽  
pp. 223-224
Author(s):  
D.H. Kim
Keyword(s):  
Bone Flap

scholarly journals Decompressive craniotomy: an international survey of practice

2021 ◽  
Author(s):  
Midhun Mohan ◽  
◽  
Hugo Layard Horsfall ◽  
Davi Jorge Fontoura Solla ◽  
Faith C. Robertson ◽  
...  
Keyword(s):  
Public Health ◽  
Randomized Trial ◽  
Bone Flap ◽  
Acute Subdural Hematoma ◽  
International Survey ◽  
Global Public Health ◽  
Health Issues ◽  
Middle Income ◽  
Middle Income Countries ◽  
Decompressive Craniotomy

Abstract Background Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating craniotomy), where a bone flap is replaced but not rigidly fixed, has comparable outcomes to DC. The primary aim of this project was to understand the current extent of usage of DC and DCO for TBI and stroke worldwide. Method A questionnaire was designed and disseminated globally via emailing lists and social media to practicing neurosurgeons between June and November 2019. Results We received 208 responses from 60 countries [40 low- and middle-income countries (LMICs)]. DC is used more frequently than DCO, however, about one-quarter of respondents are using a DCO in more than 25% of their patients. The three top indications for a DCO were an acute subdural hematoma (ASDH) and a GCS of 9-12, ASDH with contusions and a GCS of 3-8, and ASDH with contusions and a GCS of 9-12. There were 8 DCO techniques used with the majority (60/125) loosely tying sutures to the bone flap. The majority (82%) stated that they were interested in collaborating on a randomized trial of DCO vs. DC. Conclusion Our results show that DCO is a procedure carried out for TBI and stroke, especially in LMICs, and most commonly for an ASDH. The majority of the respondents were interested in collaborating on a is a future randomized trial.

Cranioplasty With Auto-Purified Bone Flap After Infection

2006 ◽  
Vol 17 (6) ◽  
pp. 1076-1079 ◽  
Author(s):  
Hiroki Yano ◽  
Katsumi Tanaka ◽  
Takayuki Matsuo ◽  
Masayoshi Tsuda ◽  
Sadanori Akita ◽  
...  
Keyword(s):  
Bone Flap

Bone Flap Necrosis After Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction

2013 ◽  
Vol 20 (1) ◽  
pp. 91-97 ◽  
Author(s):  
Christian Ewald ◽  
Pedro Duenisch ◽  
Jan Walter ◽  
Theresa Götz ◽  
Otto W. Witte ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Bone Flap ◽  
Flap Necrosis ◽  
Middle Cerebral Artery Infarction ◽  
Decompressive Hemicraniectomy

When the Bone Flap Hits the Floor

Neurosurgery ◽  
2007 ◽  
Vol 61 (6) ◽  
pp. E1340-E1340
Author(s):  
Mikhail Chernov
Keyword(s):  
Bone Flap

“Craniotomy Within Craniotomy” Technique for Safe Resection of an Intracranial Arteriovenous Malformation With Frontal Bony Erosion: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
MirHojjat Khorasanizadeh ◽  
Kristine Ravina ◽  
Aristotelis Filippidis ◽  
Christopher S Ogilvy
Keyword(s):  
Surgical Resection ◽  
Endovascular Embolization ◽  
Acute Onset ◽  
Bone Flap ◽  
Intracranial Arteriovenous Malformation ◽  
Excessive Bleeding ◽  
Left Hand ◽  
The Right ◽  
Venous Varix

Abstract Surgical resection is one option in the treatment of large high-grade brain arteriovenous malformations (AVMs). Resection of AVMs with skull-eroding components can be challenging due to the risk of excessive bleeding from these components during craniotomy and bone flap removal. We present a case of a 25-yr-old woman who presented with an acute onset right-sided frontal headache. She was found to have a large, frontal Spetzler-Martin grade IV AVM with an associated dural AVM. The AVM had caused focal erosions of the right frontal bone by a venous varix traversing the region of the calvarial defect. An elective staged endovascular embolization followed by surgical resection was recommended considering the patient's young age and the large size of the AVM located in a noneloquent area. Given the high risk of intraoperative hemorrhage during the craniotomy portion of the procedure, a “craniotomy within craniotomy” approach was planned. During this approach, a small rectangle of bone, including the portion eroded by the venous varix, was left in place, while the larger bone flap surrounding it was removed for an initial approach to the AVM. The small bony piece was safely removed at later stages of resection once the arterial feeders had been reasonably obliterated. Immediate postoperative catheter angiogram demonstrated good filling of the intracranial vascular territories with no residual AVM. The patient developed mild left facial and left hand weakness postoperatively, which resolved after 2 wk of follow-up. The patient remained neurologically intact on further follow-up.

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