Impact of cement cranioplasty on cerebrospinal fluid leaks after retrosigmoid craniotomy - A systematic review and meta-analysis

BACKGROUND

Cerebrospinal fluid (CSF) leaks and related complications (CLRC) are common after retrosigmoid approaches for cerebellopontine angle (CPA) surgeries. Bone cement cranioplasty (CCP) may provide additional sealing benefits over reconstruction without cement (RWC) in reducing these complications. This study aimed to compare the outcomes of CCP versus RWC in CPA surgery.

METHODS

A systematic review and meta-analysis following PRISMA guidelines was conducted using three databases (PubMed, Scopus, Web of Science). Studies were included comparing CCP and RWC in retrosigmoid craniotomies/craniectomies for CPA pathologies. Primary outcomes were pseudo meningocele, external CSF leaks, and CLRC, while secondary outcomes included wound infection rates and rates of reoperation for wound problems.

RESULTS

Five retrospective studies were analyzed with 1,838 patients (931 CCP, 907 RWC). CCP significantly reduced the rates of pseudo meningocele (OR 0.264, CI 0.150-0.463), wound CSF leaks (OR 0.105, CI 0.028-0.399) and CLRC (OR 0.248, CI 0.078-0.794). In the CCP group, there were fewer wound infections (OR 0.310, CI 0.114-0.790) and lower reoperation rates (OR 0.189, CI 0.050-0.708).

CONCLUSIONS

Cement cranioplasty is associated with a lower incidence of CSF leaks and related complications compared to RWC following retrosigmoid approaches for CPA pathology. CCP also reduces reoperations and wound infections. These findings support using CCP as an effective technique for lowering postoperative complications of retrosigmoid approaches.

Langerhans Cell Histiocytosis of the Skull in a Burr Hole Site Covered with Hydroxyapatite Material

BACKGROUND

Langerhans cell histiocytosis (LCH) is a rare dendritic histiocytic disorder that affects the bones, especially the skull. Langerhans cell histiocytosis (LCH) developing in a burr hole site for chronic subdural hematoma is extremely rare.

CASE DESCRIPTION

A 53-year-old man underwent a burr hole irrigation for chronic subdural hematoma, and the burr hole was covered with a burr hole button made of hydroxyapatite. Seven months after the first surgery, the connective tissue rapidly proliferated around the burr hole button, and the pathologic diagnosis was LCH. LCH recurred at 13 and 19 months after the first operation, with curettage performed each time. At 3 months after the final operation, no recurrence was identified on magnetic resonance imaging.

CONCLUSIONS

If there is rapid proliferation of connective tissue at an operative site where artificial material has been used, LCH should be considered.

Foreign Body Granuloma After Cranial Surgery: A Systematic Review of Reported Cases

BACKGROUND

In cranial surgery, different foreign body (FB) materials are used and may be left intentionally or unintentionally in the surgical field after closure, inducing a foreign body granuloma (FBG). This is a rare complication in neurosurgery, but it may be a diagnostic dilemma, with sometimes medicolegal implications.

METHODS

We performed a systematic review of the English literature between 1965 and 2018 and found a total of 77 articles concerning 100 cases of FBG caused by retained material located within the cranium or surrounding soft tissues.

RESULTS

There were 60 females and 40 males, with ages ranging from 1 to 77 years. Most initial diagnoses were cranial/intracranial tumors, trigeminal neuralgia, hemifacial spasm, intracranial aneurysm, hydrocephalus, head injury, infectious disease, and nontraumatic intracerebral hematoma. The interval from the causative surgical operation to presentation of the FBG ranged from 2 weeks to 20 years. Various radiologic modalities were used and histologic study confirmed the presence of FBG in all patients. Intentional FB was used and left in 77 patients, and unintentional FB was found postoperatively in 23 patients. Associated infection was found in 13 patients. Complete recovery was seen in 47.6% of patients with sufficient data.

CONCLUSIONS

Despite being unusual, a retained FBG should be considered in the differential diagnosis of any patient after cranial surgery. A history of surgery, clinical symptoms, physical examination findings, laboratory results, and the use of appropriate neuroimaging explorations may provide a correct preoperative diagnosis. In addition, unintentionally retained FBs are preventable errors in the operating room.