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Fenestration of bone flap during interval autologous cranioplasty.

Nguyen HS, Doan N, Wolfla C, Pollock G - Surg Neurol Int (2015)

Bottom Line: MLS for the NF group subset with drains was 1.235 ± 0.566 mm, (P = 0.587 when compared to F group).Four NF patients required reoperation compared to zero F patients (P = 0.550).Our results, regarding MLS and postoperative volume, provide support for this concept.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.

ABSTRACT

Background: Symptomatic extra-axial fluid may complicate cranioplasty and require urgent evacuation. Fenestration (F) of the bone flap may encourage extra-axial fluid absorption; however, literature has not explored this technique.

Methods: Thirty-two consecutive patients who underwent interval autologous cranioplasty were divided into two groups: Fenestration, n = 24, and no fenestration (NF), n = 8. Fenestration involves placement of twist-drill holes 1-2 cm apart throughout the bone flap. Clinical data (age, sex, underlying pathology for cranioplasty, history of antiplatelet/anticoagulation [A/A], presence of drains, and length of Intensive Care Unit [ICU] stay) were collected. Postoperative volume and midline shift (MLS) were measured. Univariate analysis was performed for continuous variables; Fisher's exact test was performed for categorical variables.

Results: For postoperative volume, NF group exhibited 33.745 ± 48.701 cm(3); F group exhibited 20.832 ± 26.103 cm(3) (P = 0.351). For MLS, NF group exhibited 3.055 ± 0.472 mm; F group exhibited 0.75 ± 0.677 mm (P = 0.009). MLS for the NF group subset with drains was 1.235 ± 0.566 mm, (P = 0.587 when compared to F group). For ICU length of stay, NF group exhibited 1.958 ± 1.732 days; F group exhibited 2.290 ± 0.835 days (P = 0.720). In NF group, for patients with no A/A, no drain exhibited MLS 4.00 ± 0.677 mm while a drain exhibited 1.845 ± 0.605 mm (P = 0.025); with A/A, no drain exhibited 5.75 ± 1.353 mm while a drain exhibited 0.625 ± 0.957 (P = 0.005). Four NF patients required reoperation compared to zero F patients (P = 0.550).

Conclusion: Presumably, fenestrations augment surface area for extra-axial fluid absorption through the bone flap. Our results, regarding MLS and postoperative volume, provide support for this concept. Accordingly, bone flap fenestration has the potential to reduce extra-axial fluid accumulation.

No MeSH data available.


Related in: MedlinePlus

Lateral skull X-ray demonstrates fenestration of the bone flap
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Figure 1: Lateral skull X-ray demonstrates fenestration of the bone flap

Mentions: The approval of the Institutional Board Review at our institution was obtained prior to the study. Between fall 2012 and spring 2015, 32 patients underwent interval autologous cranioplasty at our institution. Eight neurosurgeons performed the surgeries. The patients were divided into two groups fenestration (F) and no fenestration (NF). Fenestration involves placement of twist-drill holes 1–2 cm apart throughout the bone flap [Figure 1]. Eight patients were in the F group. Patient clinical data (age, sex, underlying pathology for the cranial defect, history of antiplatelet/anticoagulation [A/A], the presence of a drain, and length of Intensive Care Unit [ICU] stay) were collected via medical chart review. Patient demographics are listed in Table 1. For patients who did not require reoperation, the postoperative computed tomography (CT) head (obtained within 1 day of the cranioplasty) was evaluated for postoperative volume and midline shift (MLS) using a picture archiving and communication system. For patients who did require reoperation, the CT prior to reoperation was evaluated. Postoperative volume was calculated based on the XYZ/2 method as previously described.[19] Briefly, this method involves using the product of the widest (X), longest (Y), and thickest (Z) dimensions of the extra-axial fluid collection, divided by 2. The thickest dimension was calculated by multiplying the slices on which the collection was visible by the slice thickness (5 mm). The postoperative volume includes both hematoma and pneumocephalus. MLS was calculated at the axial CT slice that visualizes the foramen of Monro.


Fenestration of bone flap during interval autologous cranioplasty.

Nguyen HS, Doan N, Wolfla C, Pollock G - Surg Neurol Int (2015)

Lateral skull X-ray demonstrates fenestration of the bone flap
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697200&req=5

Figure 1: Lateral skull X-ray demonstrates fenestration of the bone flap
Mentions: The approval of the Institutional Board Review at our institution was obtained prior to the study. Between fall 2012 and spring 2015, 32 patients underwent interval autologous cranioplasty at our institution. Eight neurosurgeons performed the surgeries. The patients were divided into two groups fenestration (F) and no fenestration (NF). Fenestration involves placement of twist-drill holes 1–2 cm apart throughout the bone flap [Figure 1]. Eight patients were in the F group. Patient clinical data (age, sex, underlying pathology for the cranial defect, history of antiplatelet/anticoagulation [A/A], the presence of a drain, and length of Intensive Care Unit [ICU] stay) were collected via medical chart review. Patient demographics are listed in Table 1. For patients who did not require reoperation, the postoperative computed tomography (CT) head (obtained within 1 day of the cranioplasty) was evaluated for postoperative volume and midline shift (MLS) using a picture archiving and communication system. For patients who did require reoperation, the CT prior to reoperation was evaluated. Postoperative volume was calculated based on the XYZ/2 method as previously described.[19] Briefly, this method involves using the product of the widest (X), longest (Y), and thickest (Z) dimensions of the extra-axial fluid collection, divided by 2. The thickest dimension was calculated by multiplying the slices on which the collection was visible by the slice thickness (5 mm). The postoperative volume includes both hematoma and pneumocephalus. MLS was calculated at the axial CT slice that visualizes the foramen of Monro.

Bottom Line: MLS for the NF group subset with drains was 1.235 ± 0.566 mm, (P = 0.587 when compared to F group).Four NF patients required reoperation compared to zero F patients (P = 0.550).Our results, regarding MLS and postoperative volume, provide support for this concept.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.

ABSTRACT

Background: Symptomatic extra-axial fluid may complicate cranioplasty and require urgent evacuation. Fenestration (F) of the bone flap may encourage extra-axial fluid absorption; however, literature has not explored this technique.

Methods: Thirty-two consecutive patients who underwent interval autologous cranioplasty were divided into two groups: Fenestration, n = 24, and no fenestration (NF), n = 8. Fenestration involves placement of twist-drill holes 1-2 cm apart throughout the bone flap. Clinical data (age, sex, underlying pathology for cranioplasty, history of antiplatelet/anticoagulation [A/A], presence of drains, and length of Intensive Care Unit [ICU] stay) were collected. Postoperative volume and midline shift (MLS) were measured. Univariate analysis was performed for continuous variables; Fisher's exact test was performed for categorical variables.

Results: For postoperative volume, NF group exhibited 33.745 ± 48.701 cm(3); F group exhibited 20.832 ± 26.103 cm(3) (P = 0.351). For MLS, NF group exhibited 3.055 ± 0.472 mm; F group exhibited 0.75 ± 0.677 mm (P = 0.009). MLS for the NF group subset with drains was 1.235 ± 0.566 mm, (P = 0.587 when compared to F group). For ICU length of stay, NF group exhibited 1.958 ± 1.732 days; F group exhibited 2.290 ± 0.835 days (P = 0.720). In NF group, for patients with no A/A, no drain exhibited MLS 4.00 ± 0.677 mm while a drain exhibited 1.845 ± 0.605 mm (P = 0.025); with A/A, no drain exhibited 5.75 ± 1.353 mm while a drain exhibited 0.625 ± 0.957 (P = 0.005). Four NF patients required reoperation compared to zero F patients (P = 0.550).

Conclusion: Presumably, fenestrations augment surface area for extra-axial fluid absorption through the bone flap. Our results, regarding MLS and postoperative volume, provide support for this concept. Accordingly, bone flap fenestration has the potential to reduce extra-axial fluid accumulation.

No MeSH data available.


Related in: MedlinePlus