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Lajthia O, Chao JW, Mandelbaum M, Myseros JS, Oluigbo C, Magge SN, Zarella CS, Oh AK, Rogers GF, Keating RF. Efficacy of immediate replacement of cranial bone graft following drainage of intracranial empyema. J Neurosurg Pediatr 2018; 22:317-322. [PMID: 29932367 DOI: 10.3171/2018.3.peds17509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial empyema is a life-threatening condition associated with a high mortality rate and residual deleterious neurological effects if not diagnosed and managed promptly. The authors present their institutional experience with immediate reimplantation of the craniotomy flap and clarify the success of this method in terms of cranial integrity, risk of recurrent infection, and need for secondary procedures. METHODS A retrospective analysis of patients admitted for management of intracranial empyema during a 19-year period (1997-2016) identified 33 patients who underwent emergency drainage and decompression with a follow-up duration longer than 6 months, 23 of whom received immediate bone replacement. Medical records were analyzed for demographic information, extent and location of the infection, bone flap size, fixation method, need for further operative intervention, and duration of intravenous antibiotics. RESULTS The mean patient age at surgery was 8.7 ± 5.7 years and the infections were largely secondary to sinusitis (52.8%), with the most common location being the frontal/temporal region (61.3%). Operative intervention involved removal of a total of 31 bone flaps with a mean surface area of 22.8 ± 26.9 cm2. Nearly all (96.8%) of the bone flaps replaced at the time of the initial surgery were viable over the long term. Eighteen patients (78.3%) required a single craniotomy in conjunction with antibiotic therapy to address the infection, whereas the remaining 21.7% required more than 1 surgery. Partial bone flap resorption was noted in only 1 (3.2%) of the 31 successfully replaced bone flaps. This patient eventually had his bone flap removed and received a split-calvaria bone graft. Twenty-one patients (91.3%) received postoperative CT scans to evaluate bone integrity. The mean follow-up duration of the cohort was 43.9 ± 54.0 months. CONCLUSIONS The results of our investigation suggest that immediate replacement and stabilization of the bone flap after craniectomy for drainage of intracranial empyemas has a low risk of recurrent infection and is a safe and effective way to restore bone integrity in most patients.
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Affiliation(s)
- Orgest Lajthia
- 1Department of Neurosurgery, Children's National Medical Center, Washington, DC.,2Department of Neurosurgery, Georgetown University Medical Center, Washington, DC
| | - Jerry W Chao
- 3Department of Plastic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Max Mandelbaum
- 3Department of Plastic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - John S Myseros
- 1Department of Neurosurgery, Children's National Medical Center, Washington, DC
| | - Chima Oluigbo
- 1Department of Neurosurgery, Children's National Medical Center, Washington, DC
| | - Suresh N Magge
- 1Department of Neurosurgery, Children's National Medical Center, Washington, DC
| | | | - Albert K Oh
- 3Department of Plastic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gary F Rogers
- 5Department of Plastic Surgery, Children's National Medical Center, Washington, DC
| | - Robert F Keating
- 1Department of Neurosurgery, Children's National Medical Center, Washington, DC
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Li CH, Chou CT. Bone sparing implant removal without trephine via internal separation of the titanium body with a carbide bur. Int J Oral Maxillofac Surg 2013; 43:248-50. [PMID: 24176547 DOI: 10.1016/j.ijom.2013.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/20/2013] [Accepted: 09/17/2013] [Indexed: 11/15/2022]
Abstract
A novel technique was developed to remove osseointegrated implants without enlarging the bony socket. Immediate replacement was performed simultaneously using a same-size implant with good primary stability. The prosthesis was delivered after 6 months of healing with good loading function. Good bone stability was found at the 12-month follow-up.
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Affiliation(s)
- C H Li
- Chuan Sheng Dental Clinic, Ji'an Township, Hualien County, Taiwan.
| | - C T Chou
- Dental Department, Taipei Medical University, Da'an District, Taipei City, Taiwan
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