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Acta Neurochirurgica

Published in:

01-05-2012 | Clinical Article

Complications of delayed cranial repair after decompressive craniectomy in children less than 1 year old

Authors: Paolo Frassanito, Luca Massimi, Massimo Caldarelli, Gianpiero Tamburrini, Concezio Di Rocco

Published in: Acta Neurochirurgica | Issue 5/2012

Summary

Background

Decompressive craniectomy is an effective treatment option in case of refractory intracranial hypertension after severe head injury. The incidence of complications following cranial repair after decompressive craniectomy for traumatic brain injury is not negligible, particularly in infants and young toddlers. However, only a few dedicated papers can be found in the literature.

Method

We describe the complications observed in two boys and one girl under 1 year of age that were treated in the last decade by hemicranial decompressive craniotomy and enlarging hemispheric duraplasty, and subsequent cranial repair by means of autologous bone-flap replacement.

Findings

Despite good clinical and neurological outcome, the postoperative clinical course was complicated in all cases by early or late evidence of subdural fluid collections associated to the occurrence of hydrocephalus and causing recurrent dislocation and progressive resorption of the autologous bone flap.

Conclusions

Infants less than 1 year old, undergoing decompressive craniectomy after traumatic brain injury, experience a high rate of complications following subsequent cranial repair. Subdural collections and resorption of the autologous bone flap are to be considered as extremely common complications.

Adamo MA, Drazin A, Waldman JB (2009) Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries. J Neurosurg Ped 3:334–339CrossRef

Bolay H, Reuter U, Dunn AK, Huang Z, Boas DA, Moskowitz MA (2002) Intrinsic brain 332 activity triggers trigeminal meningeal afferents in a migraine model. Nat Med 8:136–142PubMedCrossRef

Chang V, Hartzfeld P, Langlois M, Mahmood A, Seyfried D (2010) Outcomes of cranial repair after craniectomy. J Neurosurg 112:1120–1124PubMedCrossRef

Di Rocco C, Iannelli A (2000) Hemimegalencephaly and intractable epilepsy: complications of hemispherectomy and their correlations with the surgical technique. A report on 15 cases. Pediatr Neurosurg 33(4):198–207PubMedCrossRef

Fong KD, Warren SM, Loboa EG, Henderson JH, Fang TD, Cowan CM, Carter DR, Longaker MT (2003) Mechanical strain affects dura mater biological processes: implications for immature calvarial healing. Plast Reconstr Surg 112(5):1312–1327PubMedCrossRef

Fox RJ, Walji AH, Mielke B, Petruk KC, Aronyk KE (1996) Anatomic details of intradural channels in the parasagittal dura: a possible pathway for flow of cerebrospinal fluid. Neurosurgery 39:84–90PubMedCrossRef

Friede RL, Schachenmayr W (1978) The origin of subdural neomembranes. II. Fine structural of neomembranes. Am J Pathol 92(1):69–84PubMed

Grant GA, Jolley M, Ellenbogen RG, Roberts TS, Gruss JR, Loeser JD (2004) Failure of autologous bone assisted cranioplasty following decompressive craniectomy in children and adolescents. J Neurosurg 100(2 Suppl Pediatrics):163–168CrossRef

Greenwald JA, Mehrara BJ, Spector JA, Chin GS, Steinbrech DS, Saadeh PB, Luchs JS, Paccione MF, Gittes GK, Longaker MT (2000) Biomolecular mechanisms of calvarial bone induction: immature versus mature dura mater. Plast Reconstr Surg 105(4):1382–1392PubMedCrossRef

10.

Haines DE, Harkey HL, al-Mefty O (1993) The “subdural” space: a new look at an outdated concept. Neurosurgery 32:111–120PubMedCrossRef

11.

Hannah JA (1936) The aetiology of subdural hematoma: an anatomical and pathological study. J Nerve Ment Dis 84:169–186CrossRef

12.

Hasegawa M, Yamashima T, Yamashita J, Suzuki M, Shimada S (1992) Traumatic subdural hygroma: pathology and meningeal enhancement on magnetic resonance imaging. Case report. Neurosurgery 31:580–585PubMedCrossRef

13.

Honeybul S, Ho KM (2010) Long term complications of decompressive craniectomy for head injury. J Neurotrauma 27(7):1225–1232PubMedCrossRef

14.

Iwama T, Yamada J, Imai S, Shinoda J, Funakoshi T, Sakai N (2003) The use 295 of frozen autogenous bone flaps in delayed cranioplasty revisited. Neurosurgery 52:591–596PubMedCrossRef

15.

Jannathan J, Okonkwo DO, Dumont AS, Ahmed H, Bahari A, Prevedello DM, Jane JA Sr, Jane JA Jr (2007) Outcome following decompressive craniectomy in children with severe traumatic brain injury: a 10-year single-center experience with long-term follow-up. J Neurosurg 106(4 Suppl Pediatrics):268–275

16.

Kristof RA, Grimm JM, Stoffel-Wagner B (2008) Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma. J Neurosurg 108:275–280PubMedCrossRef

17.

Mack J, Squier W, Eastman JT (2009) Anatomy and development of the meninges: implications for subdural collections and CSF circulation. Pediatr Radiol 39:200–210PubMedCrossRef

18.

Markowitz S, Saito K, Moskowitz MA (1987) Neurogenically mediated leakage of plasma protein occurs from blood vessels in dura mater but not brain. J Neurosci 7:4129–4136PubMed

19.

Miranda P, Lobato RD, Rivas JJ, Alén JF, Lagares A (2004) Postraumatic subdural collections: case report and review of the literature. Neurocirugia (Astur) 15(1):67–71

20.

Polin RS, Shaffrey ME, Bogaev CA, Tisdale N, Germanson T, Bocchicchio B, Jane JA (1997) Decompressive bifrontal craniectomy in the treatment of severe refractory post-traumatic cerebral edema. Neurosurgery 41:84–94PubMedCrossRef

21.

Posnick J, Goldstein JA, Armstrong D, Rutka JT (1993) Reconstruction of skull defects in children and adolescents by the use of fixed cranial bone grafts: long-term results. Neurosurgery 32:785–791PubMedCrossRef

22.

Prolo DJ, Oklund SA (1991) The use of bone grafts and alloplastic materials in cranioplasty. Clin Orthop 268:270–278PubMed

23.

Rish BL, Dillon JD, Meirowsky AM, Caveness WF, Mohr JP, Kistler JP, Weiss GH (1979) Cranioplasty: a review of 1030 cases of penetrating head injury. Neurosurgery 4(5):381–385PubMedCrossRef

24.

Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, Wallace D, Henning R, Tibballs J (2001) A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 17:154–162PubMedCrossRef

25.

Valença MM, Martins C, da Silva JC (2010) “In-window” craniotomy and “bridgelike” duraplasty: an alternative to decompressive hemicraniectomy. J Neurosurg 113(5):982–9PubMedCrossRef

26.

Zouros A, Bhargava R, Hoskinson M, Aronyk KE (2004) Further characterization of traumatic subdural collections of infancy. J Neurosurg 100(5 Suppl Pediatrics):512–518PubMed

Title: Complications of delayed cranial repair after decompressive craniectomy in children less than 1 year old
Authors: Paolo Frassanito
Luca Massimi
Massimo Caldarelli
Gianpiero Tamburrini
Concezio Di Rocco
Publication date: 01-05-2012
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 5/2012
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-011-1253-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Complications of delayed cranial repair after decompressive craniectomy in children less than 1 year old

Summary

Background

Method

Findings

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Summary

Background

Method

Findings

Conclusions

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