Effect of cranioplasty timing on the functional neurological outcome and postoperative complications.

BACKGROUND: The optimal timing for performing cranioplasty and its effect on functional outcome remains debatable. Multiple confounding factors may come into role; including the material used, surgical technique, cognitive assessment tools, and the overall complications. The aim of this study is to assess the neurological outcome and postoperative complications in patients who underwent early versus late cranioplasty. METHODS: A retrospective cohort study was conducted to investigate the neurological outcome and postoperative complications in patients who underwent cranioplasty between 2005 and 2018 at a Level l trauma center. Early and late cranioplasties were defined as surgeries performed within and more than 90 days of decompressive craniectomy, respectively. The Glasgow Outcome Score (GOS) and modified Rankin scale (mRS), recorded within 1 week of cranioplasty, were used to assess the neurological outcome. RESULTS: A total of 101 cases of cranioplasty were included in the study. The mean age of the patients was 31.4 ± 13.9 years. Most patients (n = 86; 85.1%) were male. The mean GOS for all patients was 4.0 ± 1.0. The mean mRS was 2.2 ± 1.78. Hydrocephalus was noted in 18 patients (early, n = 6; late, n = 12; P = 0.48). Seizures developed in 28 patients (early, n = 12; late, n = 16; P = 0.77). CONCLUSION: The neurological outcome in patients who underwent early versus late cranioplasty is almost identical. The differences in the rates of overall postoperative complications between early versus late cranioplasty were statistically insignificant. The optimal timing for performing cranioplasty is mainly dependent on the resolution of cerebral swelling.

Split Cord Malformation: Presentation, Management, and Surgical Outcome.

BACKGROUND: Split cord malformation (SCM) is a rare anomaly characterized by a split along the midline of the cord, which divides it into 2 symmetric or nonsymmetric entities. SCM surgical indications and outcomes are still debatable, the signs and symptoms are generally nonspecific and are commonly associated with other anomalies and deficits. METHODS: We retrospectively searched the hospital database at King Abdulaziz Medical City, Riyadh, Saudi Arabia for patients with SCM between 1998 and 2018. Descriptive statistics were used to present categorical data as percentages and frequencies. RESULTS: A total of 25 patients were included in this series. The mean age of patients at the time of diagnosis was 4.4 years. A total of 18 patients (72%) underwent surgical correction. The mean difference between the age at diagnosis and the age at correction was 7 months. All patients underwent intraoperative neurophysiologic monitoring. Postoperative complications were minimal. Cerebrospinal fluid leakage was noted in 2 patients, transient urinary retention was noted in 1 patient, and transient unilateral leg paresis was noted in 1 patient. Most patients (n = 15, 83%), were discharged within 19 days after surgery, and 81% showed improvement postoperatively. Over the long-term follow-up, none of the patients developed new urologic or neurologic deficits. CONCLUSIONS: Most patients with SCM present during childhood. Postoperative complications after SCM corrective surgery are generally minimal, and the overall outcomes, mainly including partial or complete symptomatic improvement and/or symptom stability and hydronephrosis resolution, were favorable.

Predictors of Surgical Site Infection in Autologous Cranioplasty: A Retrospective Analysis of Subcutaneously Preserved Bone Flaps in Abdominal Pockets.

BACKGROUND: Decompressive craniectomy (DC) is a surgical procedure performed to manage intracranial hypertension. Once performed, patients are obligated to undergo another surgical procedure known as cranioplasty to reconstruct the cranial defect. Cranioplasty still has one of the highest rates of infection. The factors contributing to the high rate of surgical site infection (SSI) after cranioplasty are not well established. This study aims to estimate the incidence of SSI and determine its possible risk factors for patients who underwent cranioplasty using bone flaps subcutaneously preserved in abdominal pockets. METHODS: A retrospective cohort study was conducted to investigate the predictors of infection among patients who underwent cranioplasty from subcutaneously preserved bone flaps in abdominal pockets between January 2005 and December 2018 at a level l trauma center. RESULTS: A total of 103 cases of cranioplasty from subcutaneously preserved bone flaps were included in the study. The mean age of the patients was 31.2 ± 14.8 years (range, 5-67 years). The median interval between DC and cranioplasty was 115 days. The most frequent indication for DC was traumatic brain injury (76.4%). The incidence of SSI was noted in 15.7% of patients. The most significant predictors of infection in patients requiring cranioplasty were blood glucose levels and skull defect size (P = 0.03 and P = 0.02, respectively). CONCLUSIONS: Blood glucose levels and skull defect size were the only identifiable risk factors associated with SSI. Storing bone flaps in subcutaneous abdominal pockets is cost-efficient but carries considerable risk of infection.