Outcomes Of Immediate Titanium Cranioplasty Following Postcraniotomy Infections: A Systematic Review Of The Literature
Adee J. Heiman, M.D., Ankoor A. Talwar, M.B.A., Deepa K. Bhat, M.D., Joseph A. Ricci, M.D..
Albany Medical Center, Albany, NY, USA.
PURPOSE: When craniotomy complicated by surgical site infection (SSI) requires bony debridement and craniectomy, the bony defect is typically not reconstructed immediately. Due to concerns about placing a prosthetic material in an infected field, cranioplasty is usually delayed by weeks or months after secondary craniectomy. However, surgeons have begun performing single-stage cranioplasty after craniectomy in an effort to reduce the morbidity associated with multiple procedures and reduce overall healthcare costs. The purpose of this systematic review is to analyze outcomes of immediate cranioplasty performed after bone flap debridement for post-craniotomy infections.
METHODS: A literature review from 1/1/1998 through 1/1/2019 was conducted according to PRISMA guidelines, using combinations of the search terms "cranioplasty," "craniectomy," "postcraniotomy infection," "debridement," "titanium," "immediate," and "delayed." Four articles discussing immediate titanium cranioplasty in the setting of post-craniotomy infection were identified. No articles were identified that provided exclusive data on delayed titanium cranioplasty following bone flap debridement were identified. These articles were reviewed for complications.
RESULTS: There were 40 patients who underwent immediate cranioplasty after bone flap debridement. Three of these patients underwent concomitant free flap reconstruction. Overall, only two patients developed re-infection (5%). Five patients required unplanned return to the operating room (12.5%), three for CSF leak, one for re-infection, and one for subdural hematoma. There was one case of minor wound necrosis and one death in the immediate post-op period that was secondary to unrelated issues.
CONCLUSION: While no data focusing on delayed titanium cranioplasty after bone debridement could be found in the literature, the complication rates were similar to studies looking at delayed all-material cranioplasties after bone debridement and delayed titanium cranioplasties after all-purpose craniectomies. Given these outcomes, immediate titanium cranioplasty should be considered in select patients.
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