Complications following pediatric cranioplasty after decompressive craniectomy

A multicenter retrospective study

Brandon G. Rocque, Bonita S. Agee, Eric M. Thompson, Mark Piedra, Lissa Baird, Nathan Selden, Stephanie Greene, Christopher P. Deibert, Todd C. Hankinson, Sean M. Lew, Bermans J. Iskandar, Taryn M. Bragg, David Frim, Gerald Grant, Nalin Gupta, Kurtis I. Auguste, Dimitrios C. Nikas, Michael Vassilyadi, Carrie R. Muh, Nicholas M. Wetjen & 1 others Sandi K. Lam

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: In children, the repair of skull defects arising from decompressive craniectomy presents a unique set of challenges. Single-center studies have identified different risk factors for the common complications of cranioplasty resorption and infection. The goal of the present study was to determine the risk factors for bone resorption and infection after pediatric cranioplasty. Methods: The authors conducted a multicenter retrospective case study that included all patients who underwent cranioplasty to correct a skull defect arising from a decompressive craniectomy at 13 centers between 2000 and 2011 and were less than 19 years old at the time of cranioplasty. Prior systematic review of the literature along with expert opinion guided the selection of variables to be collected. These included: indication for craniectomy; history of abusive head trauma; method of bone storage; method of bone fixation; use of drains; size of bone graft; presence of other implants, including ventriculoperitoneal (VP) shunt; presence of fluid collections; age at craniectomy; and time between craniectomy and cranioplasty. Results: A total of 359 patients met the inclusion criteria. The patients' mean age was 8.4 years, and 51.5% were female. Thirty-eight cases (10.5%) were complicated by infection. In multivariate analysis, presence of a cranial implant (primarily VP shunt) (OR 2.41, 95% CI 1.17-4.98), presence of gastrostomy (OR 2.44, 95% CI 1.03-5.79), and ventilator dependence (OR 8.45, 95% CI 1.10-65.08) were significant risk factors for cranioplasty infection. No other variable was associated with infection. Of the 240 patients who underwent a cranioplasty with bone graft, 21.7% showed bone resorption significant enough to warrant repeat surgical intervention. The most important predictor of cranioplasty bone resorption was age at the time of cranioplasty. For every month of increased age the risk of bone flap resorption decreased by 1% (OR 0.99, 95% CI 0.98-0.99, p < 0.001). Other risk factors for resorption in multivariate models were the use of external ventricular drains and lumbar shunts. Conclusions: This is the largest study of pediatric cranioplasty outcomes performed to date. Analysis included variables found to be significant in previous retrospective reports. Presence of a cranial implant such as VP shunt is the most significant risk factor for cranioplasty infection, whereas younger age at cranioplasty is the dominant risk factor for bone resorption.

Original languageEnglish (US)
Pages (from-to)225-232
Number of pages8
JournalJournal of Neurosurgery: Pediatrics
Volume22
Issue number3
DOIs
StatePublished - Sep 1 2018

Fingerprint

Decompressive Craniectomy
Multicenter Studies
Bone Resorption
Retrospective Studies
Pediatrics
Ventriculoperitoneal Shunt
Infection
Bone and Bones
Skull
Transplants
Gastrostomy
Expert Testimony
Mechanical Ventilators
Craniocerebral Trauma
Multivariate Analysis

Keywords

  • Bone resorption
  • Complication
  • Cranioplasty
  • Infection
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Complications following pediatric cranioplasty after decompressive craniectomy : A multicenter retrospective study. / Rocque, Brandon G.; Agee, Bonita S.; Thompson, Eric M.; Piedra, Mark; Baird, Lissa; Selden, Nathan; Greene, Stephanie; Deibert, Christopher P.; Hankinson, Todd C.; Lew, Sean M.; Iskandar, Bermans J.; Bragg, Taryn M.; Frim, David; Grant, Gerald; Gupta, Nalin; Auguste, Kurtis I.; Nikas, Dimitrios C.; Vassilyadi, Michael; Muh, Carrie R.; Wetjen, Nicholas M.; Lam, Sandi K.

In: Journal of Neurosurgery: Pediatrics, Vol. 22, No. 3, 01.09.2018, p. 225-232.

Research output: Contribution to journalArticle

Rocque, BG, Agee, BS, Thompson, EM, Piedra, M, Baird, L, Selden, N, Greene, S, Deibert, CP, Hankinson, TC, Lew, SM, Iskandar, BJ, Bragg, TM, Frim, D, Grant, G, Gupta, N, Auguste, KI, Nikas, DC, Vassilyadi, M, Muh, CR, Wetjen, NM & Lam, SK 2018, 'Complications following pediatric cranioplasty after decompressive craniectomy: A multicenter retrospective study', Journal of Neurosurgery: Pediatrics, vol. 22, no. 3, pp. 225-232. https://doi.org/10.3171/2018.3.PEDS17234
Rocque, Brandon G. ; Agee, Bonita S. ; Thompson, Eric M. ; Piedra, Mark ; Baird, Lissa ; Selden, Nathan ; Greene, Stephanie ; Deibert, Christopher P. ; Hankinson, Todd C. ; Lew, Sean M. ; Iskandar, Bermans J. ; Bragg, Taryn M. ; Frim, David ; Grant, Gerald ; Gupta, Nalin ; Auguste, Kurtis I. ; Nikas, Dimitrios C. ; Vassilyadi, Michael ; Muh, Carrie R. ; Wetjen, Nicholas M. ; Lam, Sandi K. / Complications following pediatric cranioplasty after decompressive craniectomy : A multicenter retrospective study. In: Journal of Neurosurgery: Pediatrics. 2018 ; Vol. 22, No. 3. pp. 225-232.
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abstract = "Objective: In children, the repair of skull defects arising from decompressive craniectomy presents a unique set of challenges. Single-center studies have identified different risk factors for the common complications of cranioplasty resorption and infection. The goal of the present study was to determine the risk factors for bone resorption and infection after pediatric cranioplasty. Methods: The authors conducted a multicenter retrospective case study that included all patients who underwent cranioplasty to correct a skull defect arising from a decompressive craniectomy at 13 centers between 2000 and 2011 and were less than 19 years old at the time of cranioplasty. Prior systematic review of the literature along with expert opinion guided the selection of variables to be collected. These included: indication for craniectomy; history of abusive head trauma; method of bone storage; method of bone fixation; use of drains; size of bone graft; presence of other implants, including ventriculoperitoneal (VP) shunt; presence of fluid collections; age at craniectomy; and time between craniectomy and cranioplasty. Results: A total of 359 patients met the inclusion criteria. The patients' mean age was 8.4 years, and 51.5{\%} were female. Thirty-eight cases (10.5{\%}) were complicated by infection. In multivariate analysis, presence of a cranial implant (primarily VP shunt) (OR 2.41, 95{\%} CI 1.17-4.98), presence of gastrostomy (OR 2.44, 95{\%} CI 1.03-5.79), and ventilator dependence (OR 8.45, 95{\%} CI 1.10-65.08) were significant risk factors for cranioplasty infection. No other variable was associated with infection. Of the 240 patients who underwent a cranioplasty with bone graft, 21.7{\%} showed bone resorption significant enough to warrant repeat surgical intervention. The most important predictor of cranioplasty bone resorption was age at the time of cranioplasty. For every month of increased age the risk of bone flap resorption decreased by 1{\%} (OR 0.99, 95{\%} CI 0.98-0.99, p < 0.001). Other risk factors for resorption in multivariate models were the use of external ventricular drains and lumbar shunts. Conclusions: This is the largest study of pediatric cranioplasty outcomes performed to date. Analysis included variables found to be significant in previous retrospective reports. Presence of a cranial implant such as VP shunt is the most significant risk factor for cranioplasty infection, whereas younger age at cranioplasty is the dominant risk factor for bone resorption.",
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TY - JOUR

T1 - Complications following pediatric cranioplasty after decompressive craniectomy

T2 - A multicenter retrospective study

AU - Rocque, Brandon G.

AU - Agee, Bonita S.

AU - Thompson, Eric M.

AU - Piedra, Mark

AU - Baird, Lissa

AU - Selden, Nathan

AU - Greene, Stephanie

AU - Deibert, Christopher P.

AU - Hankinson, Todd C.

AU - Lew, Sean M.

AU - Iskandar, Bermans J.

AU - Bragg, Taryn M.

AU - Frim, David

AU - Grant, Gerald

AU - Gupta, Nalin

AU - Auguste, Kurtis I.

AU - Nikas, Dimitrios C.

AU - Vassilyadi, Michael

AU - Muh, Carrie R.

AU - Wetjen, Nicholas M.

AU - Lam, Sandi K.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Objective: In children, the repair of skull defects arising from decompressive craniectomy presents a unique set of challenges. Single-center studies have identified different risk factors for the common complications of cranioplasty resorption and infection. The goal of the present study was to determine the risk factors for bone resorption and infection after pediatric cranioplasty. Methods: The authors conducted a multicenter retrospective case study that included all patients who underwent cranioplasty to correct a skull defect arising from a decompressive craniectomy at 13 centers between 2000 and 2011 and were less than 19 years old at the time of cranioplasty. Prior systematic review of the literature along with expert opinion guided the selection of variables to be collected. These included: indication for craniectomy; history of abusive head trauma; method of bone storage; method of bone fixation; use of drains; size of bone graft; presence of other implants, including ventriculoperitoneal (VP) shunt; presence of fluid collections; age at craniectomy; and time between craniectomy and cranioplasty. Results: A total of 359 patients met the inclusion criteria. The patients' mean age was 8.4 years, and 51.5% were female. Thirty-eight cases (10.5%) were complicated by infection. In multivariate analysis, presence of a cranial implant (primarily VP shunt) (OR 2.41, 95% CI 1.17-4.98), presence of gastrostomy (OR 2.44, 95% CI 1.03-5.79), and ventilator dependence (OR 8.45, 95% CI 1.10-65.08) were significant risk factors for cranioplasty infection. No other variable was associated with infection. Of the 240 patients who underwent a cranioplasty with bone graft, 21.7% showed bone resorption significant enough to warrant repeat surgical intervention. The most important predictor of cranioplasty bone resorption was age at the time of cranioplasty. For every month of increased age the risk of bone flap resorption decreased by 1% (OR 0.99, 95% CI 0.98-0.99, p < 0.001). Other risk factors for resorption in multivariate models were the use of external ventricular drains and lumbar shunts. Conclusions: This is the largest study of pediatric cranioplasty outcomes performed to date. Analysis included variables found to be significant in previous retrospective reports. Presence of a cranial implant such as VP shunt is the most significant risk factor for cranioplasty infection, whereas younger age at cranioplasty is the dominant risk factor for bone resorption.

AB - Objective: In children, the repair of skull defects arising from decompressive craniectomy presents a unique set of challenges. Single-center studies have identified different risk factors for the common complications of cranioplasty resorption and infection. The goal of the present study was to determine the risk factors for bone resorption and infection after pediatric cranioplasty. Methods: The authors conducted a multicenter retrospective case study that included all patients who underwent cranioplasty to correct a skull defect arising from a decompressive craniectomy at 13 centers between 2000 and 2011 and were less than 19 years old at the time of cranioplasty. Prior systematic review of the literature along with expert opinion guided the selection of variables to be collected. These included: indication for craniectomy; history of abusive head trauma; method of bone storage; method of bone fixation; use of drains; size of bone graft; presence of other implants, including ventriculoperitoneal (VP) shunt; presence of fluid collections; age at craniectomy; and time between craniectomy and cranioplasty. Results: A total of 359 patients met the inclusion criteria. The patients' mean age was 8.4 years, and 51.5% were female. Thirty-eight cases (10.5%) were complicated by infection. In multivariate analysis, presence of a cranial implant (primarily VP shunt) (OR 2.41, 95% CI 1.17-4.98), presence of gastrostomy (OR 2.44, 95% CI 1.03-5.79), and ventilator dependence (OR 8.45, 95% CI 1.10-65.08) were significant risk factors for cranioplasty infection. No other variable was associated with infection. Of the 240 patients who underwent a cranioplasty with bone graft, 21.7% showed bone resorption significant enough to warrant repeat surgical intervention. The most important predictor of cranioplasty bone resorption was age at the time of cranioplasty. For every month of increased age the risk of bone flap resorption decreased by 1% (OR 0.99, 95% CI 0.98-0.99, p < 0.001). Other risk factors for resorption in multivariate models were the use of external ventricular drains and lumbar shunts. Conclusions: This is the largest study of pediatric cranioplasty outcomes performed to date. Analysis included variables found to be significant in previous retrospective reports. Presence of a cranial implant such as VP shunt is the most significant risk factor for cranioplasty infection, whereas younger age at cranioplasty is the dominant risk factor for bone resorption.

KW - Bone resorption

KW - Complication

KW - Cranioplasty

KW - Infection

KW - Trauma

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