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Magni F, Al-Omari A, Vardanyan R, Rad AA, Honeyman S, Boukas A. An update on a persisting challenge: A systematic review and meta-analysis of the risk factors for surgical site infection post craniotomy. Am J Infect Control 2024; 52:650-658. [PMID: 37989412 DOI: 10.1016/j.ajic.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) postcraniotomy continue to impose a significant burden on health care systems and patient outcomes. It is, therefore, important to understand their risk factors in order to promote effective preventative measures. This meta-analysis aims to provide a comprehensive, up-to-date analysis of the risk factors associated with SSIs in neurosurgical procedures. METHODS A systematic review was conducted as per preferred reporting items for systematic reviews and meta-analysis guidelines to explore existing primary evidence on the risk factors for SSIs postcraniotomy. A comprehensive search of MEDLINE, EMBASE, and Pubmed was performed from database inception up to June 2023. 43 studies were included in the meta-analysis, encompassing a total of 68,881 patients. RESULTS The strongest predictor for SSIs was found to be cerebrospinal fluid (CSF) leak (OR: 8.91, CI: 4.30-18.44). Other significant factors included infratentorial surgery (OR: 0.43, CI: 0.31-0.61), emergency surgery (OR: 1.41, CI: 1.05-1.91), reintervention (OR: 3.19, CI: 1.77-5.75), prolonged operative time (mean difference: 33.25; CI: 18.83-47.67), hospital length of stay (mean difference: 0.60; CI: 0.23-0.98) and intracranial pressure monitor (ICPM) insertion (OR: 1.81; CI: 1.06-3.11). Contrarily, sex, body mass index (BMI), diabetes, antibiotic prophylaxis, immunosuppressive agents, trauma, use of artificial implants did not demonstrate statistical significance. CONCLUSIONS This meta-analysis provides an up-to-date and comprehensive evaluation of risk factors for SSIs postcraniotomy. It emphasizes the need for preventive strategies, particularly against CSF leaks, and calls for further research to elucidate the intricate relationships between these factors.
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Affiliation(s)
- Francesco Magni
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
| | - Aws Al-Omari
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Robert Vardanyan
- Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arian A Rad
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Susan Honeyman
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Alexandros Boukas
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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Jain S, Helmy A, Santarius T, Owen N, Grieve K, Hutchinson P, Timofeev I. Customised pre-operative cranioplasty to achieve maximal surgical resection of tumours with osseous involvement-a case series. Acta Neurochir (Wien) 2024; 166:152. [PMID: 38532155 DOI: 10.1007/s00701-024-06055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Surgical resection with bony margins would be the treatment of choice for tumours with osseous involvement such as meningiomas and metastasis. By developing and designing pre-operative customised 3D modelled implants, the patient can undergo resection of meningioma and repair of bone defect in the same operation. We present a generalisable method for designing pre-operative cranioplasty in patients to repair the bone defect after the resection of tumours. MATERIALS AND METHODS We included six patients who presented with a tumour that was associated with overlying bone involvement. They underwent placement of customised cranioplasty in the same setting. A customised implant using a pre-operative imaging was designed with a 2-cm margin to allow for any intra-operative requirements for extending the craniectomy. RESULTS Six patients were evaluated in this case series. Four patients had meningiomas, 1 patient had metastatic breast cancer on final histology, and 1 patient was found to have an intra-osseous arteriovenous malformation. Craniectomy based on margins provided by a cutting guide was fashioned. After tumour removal and haemostasis, the cranioplasty was then placed. All patients recovered well post-operatively with satisfactory cosmetic results. No wound infection was reported in our series. CONCLUSION Our series demonstrate the feasibility of utilising pre-designed cranioplasty for meningiomas and other tumours with osseous involvement. Following strict infection protocols, minimal intra-operative handling/modification of the implant, and close follow-up has resulted in good cosmetic outcomes with no implant-related infections.
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Affiliation(s)
- Swati Jain
- Divison of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 1TN, UK.
| | - Adel Helmy
- Divison of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 1TN, UK
| | - Thomas Santarius
- Divison of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 1TN, UK
| | - Nicola Owen
- Divison of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 1TN, UK
| | - Kirsty Grieve
- Divison of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 1TN, UK
| | - Peter Hutchinson
- Divison of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 1TN, UK
| | - Ivan Timofeev
- Divison of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 1TN, UK
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Mannella FC, Faedo F, Fumagalli M, Norata GD, Zaed I, Servadei F. Long-Term Follow-Up of Custom-Made Porous Hydroxyapatite Cranioplasties: Analysis of Infections in Adult and Pediatric Patients. J Clin Med 2024; 13:1133. [PMID: 38398446 PMCID: PMC10888657 DOI: 10.3390/jcm13041133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
In neurosurgery, cranioplasty (CP) stands as a pivotal surgical intervention, particularly following head trauma or various neurosurgical interventions. This study scrutinizes the intricacies of CP, emphasizing its prevalence and associated complications, with a specific focus on custom-made porous hydroxyapatite (PHA) implants. The investigation spans 687 patients (with 80 patients of pediatric age, less than 14 years old) across 26 neurosurgical centers in five European countries. Methodologically, this study delves into patient characteristics, complications, and infection data through a comprehensive post-marketing on-site surveillance approach. Notably, infections emerged as the primary complication, affecting 41 patients (6% of implants) with a clear distinction in onset patterns between pediatric (with more infections, 10% versus 5.4% in adults and an earlier onset of complications) and adult populations. Out of these 41 cases, cranioplasty explantation was required in 30 patients, 4.4% of the total population. Furthermore, bifrontal decompression correlated with a significantly elevated infection risk as compared to unilateral decompression (12.5% versus 5.1%) which remains after the examination of possible confounding factors. These findings provide substantial insights into the complexities of CP, suggesting the necessity for tailored strategies in pediatric and adult cases and cautioning against bifrontal decompressions. Despite acknowledging limitations and calling for prospective studies with long term follow-up, this research advances our understanding of the use of PHA CP, guiding clinical decision-making and emphasizing the importance of customized approaches for diverse patient cohorts.
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Affiliation(s)
- Francesca Carolina Mannella
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milano, 20133 Milan, Italy; (M.F.); (G.D.N.)
| | - Francesca Faedo
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Marta Fumagalli
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milano, 20133 Milan, Italy; (M.F.); (G.D.N.)
| | - Giuseppe Danilo Norata
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milano, 20133 Milan, Italy; (M.F.); (G.D.N.)
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, CH-2900 Lugano, Switzerland;
| | - Franco Servadei
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
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Cardona S, Hernández C, Bohórquez-Tarazona MP, Rubiano AM, Parra DMS. Scalp wound management: a narrative review from a neurosurgical perspective. J Wound Care 2024; 33:127-135. [PMID: 38329834 DOI: 10.12968/jowc.2024.33.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of surgical, traumatic and pressure injuries in the scalp, which are common in neurosurgery practice. METHOD We searched PubMed for publications and book chapters in English from 2011 to 2021. We also included commonly referenced papers that we considered relevant to the subject with publication before these dates. We used the search terms 'laceration,' and/or 'neurosurgery' and/or, 'pressure injury,' and/or 'craniotomy,' and/or 'surgical incision' in combination with 'scalp,' and/or 'wound care.' We also searched the reference lists of publications identified by the search strategy and selected those that we judged relevant. RESULTS We pre-selected 52 articles that covered various aspects of anatomy, pathophysiology, scalp wound management, or general wound care that we considered applied to the anatomical region of our interest. After abstract review, we selected 34 articles that met our search criteria and were included in our review. CONCLUSION There is limited evidence regarding classification and care of scalp wounds. As a result, many of the current practices for scalp wound management are based on evidence derived from studies involving different anatomical regions, not considering its particular anatomy, vasculature and microbiome. Further research is needed for more comprehensive and effective protocols for the management of scalp injuries. However, this present review proposes responses to the identified gaps concerning the management of scalp wounds.
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Affiliation(s)
| | | | | | - Andrés M Rubiano
- Meditech Foundation, Barrow Neurological Institute at Phoenix Children's Hospital, US
- Valle Salud IPS Clinic Network, Colombia
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, UK
| | - Diana Marcela Sánchez Parra
- Meditech Foundation, Barrow Neurological Institute at Phoenix Children's Hospital, US
- Fellow, Global Neurosurgery and Trauma, University of Cambridge, UK
- Fundación Meditech, Cali, Colombia
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Dechaene V, Gallet C, Soueges S, Liu L, Delabar V, Adélaïde L, Jarraud S, Dauwalder O, Jouanneau E, Wan M, Jacquesson T, Guyotat J, Conrad A, Triffault-Fillit C, Ferry T, Valour F. Diagnostic, clinical management, and outcome of bone flap-related osteomyelitis after cranioplasty. Int J Infect Dis 2023; 137:48-54. [PMID: 37839505 DOI: 10.1016/j.ijid.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES We aimed to describe diagnostic, management, and outcome of bone flap-related osteomyelitis after cranioplasty. METHODS Patients followed up in our tertiary care hospital for bone flap-related osteomyelitis after cranioplasty were included in a retrospective cohort (2008-2021). Determinants of treatment failure were assessed using logistic regression and Kaplan-Meier curves analysis. RESULTS The 144 included patients (81 [56.3%] males; median age 53.4 [interquartile range [IQR], 42.6-62.5] years) mostly presented wound abnormalities (n = 115, 79.9%). All infections were documented, the main pathogens being Staphylococcus aureus (n = 64, 44.4%), Cutibacterium acnes (n = 57, 39.6%), gram-negative bacilli (n = 40, 27.8%) and/or non-aureus staphylococci (n = 34, 23.6%). Surgery was performed in 140 (97.2%) cases, for bone flap removal (n = 102, 72.9%) or debridement with flap retention (n = 31, 22.1%), along with 12.7 (IQR, 8.0-14.0) weeks of antimicrobial therapy. After a follow-up of 117.1 (IQR, 62.5-235.5) weeks, 37 (26.1%) failures were observed: 16 (43.2%) infection persistence, three (8.1%) relapses, 22 (59.5%) superinfections and/or two (1.7%) infection-related deaths. Excluding superinfections, determinants of the 19 (13.4%) specific failures were an index craniectomy for brain tumor (odds ratio = 4.038, P = 0.033) and curettage of bone edges (odds ratio = 0.342, P = 0.048). CONCLUSION Post-craniectomy bone flap osteomyelitis are difficult-to-treat infection, necessitating prolonged antimicrobial therapy with appropriate surgical debridement, and advocating for multidisciplinary management in dedicated reference centers.
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Affiliation(s)
- Victor Dechaene
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Clémentine Gallet
- Department of Neurosurgery D, Tumoral and Vascular Malformation Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Sarah Soueges
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Lannie Liu
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Violaine Delabar
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Léopold Adélaïde
- Department of Infectious Diseases, Lucien Husset Hospital, Vienne, France
| | - Sophie Jarraud
- 24/24 Microbiology Plateforme, Infectious Agent Institute, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Olivier Dauwalder
- 24/24 Microbiology Plateforme, Infectious Agent Institute, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Marie Wan
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Timothée Jacquesson
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France; Department of Anatomy, University of Lyon 1, Lyon, France; CREATIS Laboratory, CNRS UMR5220, Inserm U1044, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Jacques Guyotat
- Department of Neurosurgery D, Tumoral and Vascular Malformation Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Anne Conrad
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Claire Triffault-Fillit
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Florent Valour
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.
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Scalp complications of craniofacial surgery: classification, prevention, and initial approach: an updated review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-02008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Scalp complications in craniofacial surgeries can increase morbidity and mortality. Given the inelastic characteristics of the scalp, these surgeries can be challenging, and multiple complications can arise. The literature on craniofacial surgery is extensive. However, few articles address scalp complications, associated factors, and prevention. This study aims to identify and classify scalp complications in craniofacial surgery and describe associated risk factors, general preventive measures, and an initial therapeutic approach.
Methods
We conducted a literature search in PubMed, Scopus, Cochrane Library, and LILACS to review the scalp complications in craniofacial surgery. The studies selected included retrospective case series, narrative reviews, systematic reviews, and cadaveric anatomic studies. We completed the search with book chapters and specific topic reviews.
Results
We screened a total of 124 sources and selected 35 items for inclusion in this review. Based on the updated review, we categorized scalp complications into wound defects, soft tissue contour irregularities, neurovascular defects, and infection. We discuss the main characteristics, risk factors, preventive measures, and initial management of these complications.
Conclusions
For craniofacial surgery, understanding the surgical anatomy, identifying risk factors, adequate surgical planning, and interdisciplinary cooperation between neurosurgeons, plastic surgeons, and the interdisciplinary team are essential to prevent and treat scalp complications.
Level of evidence: Not ratable
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Pitak-Arnnop P. An evidence-based approach to antibiotic prophylaxis for oral, craniomaxillofacial plastic/head and neck surgical procedures. J Clin Pharm Ther 2022; 47:844-850. [PMID: 35132644 DOI: 10.1111/jcpt.13618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Mindermann T. Empirically adapted or personalized antibiotic prophylaxis in select cranial neurosurgery? Acta Neurochir (Wien) 2021; 163:365-367. [PMID: 32876765 DOI: 10.1007/s00701-020-04558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
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