TY - JOUR
T1 - Multidisciplinary approach for improved outcomes in secondary cranial reconstruction
T2 - Introducing the pericranial-onlay cranioplasty technique
AU - Gordon, Chad R.
AU - Fisher, Mark
AU - Liauw, Jason
AU - Lina, Ioan
AU - Puvanesarajah, Varun
AU - Susarla, Srinivas
AU - Coon, Alexander
AU - Lim, Michael
AU - Quinones-Hinojosa, Alfredo
AU - Weingart, Jon
AU - Colby, Geoffrey
AU - Olivi, Alessandro
AU - Huang, Judy
N1 - Publisher Copyright:
© 2014 by the Congress of Neurological Surgeons.
PY - 1982
Y1 - 1982
N2 - Background: Although materials for secondary cranial reconstruction have evolved with time, the overall approach in terms of bone flap/implant reconstruction after necessary delay has remained constant. Objective: To present our cases series of 50 consecutive secondary cranial reconstruction patients and to describe a multidisciplinary cranioplasty approach developed to reduce morbidity, to minimize infection, and to improve aesthetic appearance. Methods: Standard technique teaches us to place the bone flap and/or alloplastic implant directly over the dura or dural protectant after scalp flap re-elevation. However, this procedure is fraught with high complication rates, including infection. While raising the previously incised scalp flap overlying the full-thickness calvarial defect, the dissection is performed within the loose areolar tissue plane beneath the galea aponeurosis, thus leaving vascularized pericranium intact over the dura. Results: A total of 50 consecutive patients were treated by the senior author encompassing 46 cranioplasties using the pericranial-onlay approach, along with 4 isolated temporal soft tissue reconstructions with liquid poly-methyl-methacrylate. Of the 46 cranioplasties (> 5 cm2), only 1 autologous bone flap developed deep infection necessitating bone flap removal (1 of 46, 2.17%; 95% confidence interval, 0.003-11.3). None of the alloplastic custom implants placed have developed any infection requiring removal. Conclusion: This multidisciplinary approach illustrated in our case series, including our "pericranial-onlay" technique described here for the first time, has the potential to improve patient outcomes, to decrease perioperative morbidity, and to minimize costs associated with postoperative infections after secondary cranial reconstruction.
AB - Background: Although materials for secondary cranial reconstruction have evolved with time, the overall approach in terms of bone flap/implant reconstruction after necessary delay has remained constant. Objective: To present our cases series of 50 consecutive secondary cranial reconstruction patients and to describe a multidisciplinary cranioplasty approach developed to reduce morbidity, to minimize infection, and to improve aesthetic appearance. Methods: Standard technique teaches us to place the bone flap and/or alloplastic implant directly over the dura or dural protectant after scalp flap re-elevation. However, this procedure is fraught with high complication rates, including infection. While raising the previously incised scalp flap overlying the full-thickness calvarial defect, the dissection is performed within the loose areolar tissue plane beneath the galea aponeurosis, thus leaving vascularized pericranium intact over the dura. Results: A total of 50 consecutive patients were treated by the senior author encompassing 46 cranioplasties using the pericranial-onlay approach, along with 4 isolated temporal soft tissue reconstructions with liquid poly-methyl-methacrylate. Of the 46 cranioplasties (> 5 cm2), only 1 autologous bone flap developed deep infection necessitating bone flap removal (1 of 46, 2.17%; 95% confidence interval, 0.003-11.3). None of the alloplastic custom implants placed have developed any infection requiring removal. Conclusion: This multidisciplinary approach illustrated in our case series, including our "pericranial-onlay" technique described here for the first time, has the potential to improve patient outcomes, to decrease perioperative morbidity, and to minimize costs associated with postoperative infections after secondary cranial reconstruction.
KW - Cranial reconstruction
KW - Craniofacial surgery
KW - Cranioplasty
KW - Pericranial onlay
KW - Pterional custom cranial implant
KW - Skull defect
KW - Temporal soft tissue reconstruction
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U2 - 10.1227/NEU.0000000000000296
DO - 10.1227/NEU.0000000000000296
M3 - Article
C2 - 24448187
AN - SCOPUS:84926253168
SN - 0148-396X
VL - 10
SP - 179
EP - 189
JO - Neurosurgery
JF - Neurosurgery
ER -