Newswise — Winner of the DePuy Synthes Resident Craniofacial Award, Ryan Patrick Morton, MD, presented his research, Timing of Cranioplasty: A 10-year Single-center Analysis of 754 Patients, during the 2016 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.
Despite technical simplicity, cranioplasty procedures harbor high reported morbidity rates. This represents the largest study to date on complications after cranioplasty, focusing specifically on the ideal timing of the operation.
The authors retrospectively reviewed all cranioplasties performed at Harborview Medical Center over the past 10.75 years: over 750 procedures. 60 percent were male with an average follow up of 533 days. 30-day mortality was 0.26% percent (n=2, both due to post-operative epidural hematoma). The morbidity was 22.7 percent, including infection necessitating explanation of the flap (6.6 percent), post-operative hydrocephalus requiring a shunt (5.7 percent), resorption of flap (4.5 percent), seizure (3.4 percent), post-operative hematoma requiring evacuation (0.9 percent) and other (1.6 percent).
When evaluating complication rates against the timing of the cranioplasty, the authors found infection was significantly higher when the cranioplasty was performed 14 days from the original decompression. Hydrocephalus was statistically less common in patients whose cranioplasty was performed after 90 days; however, new onset seizure occurred only in patients who received their cranioplasty at less than 90 days. The resorption rate was lowest when the cranioplasty was performed within 15–30 days from the original decompression and was also statistically influenced by patient age. The hazard ratio for resorption decreased by 33 percent per increase of 10 years of age.
While the ideal timing for cranioplasty remains controversial, the data suggests that performing the procedure between two and four weeks helps minimize infection, seizure and resorption. Waiting less than 90 days minimizes hydrocephalus but also significantly increases risk of seizure.
Author Block: Ryan Patrick Morton, MD; I. Abecassis, MD; Josiah Hanson, BS; Jason Barber, MS; Mimi Chen; John Nerve, MD; Samuel Emerson, MD, PhD; Chibawanye Ene, MD, PhD; Michael Levitt, MD; Michelle Chowdhary, MD; Andrew Ko, MD
Disclosure: The author reported no conflicts of interest.
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About the 2016 AANS Annual Scientific Meeting: Attended by neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals, the AANS Annual Scientific Meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. More than 1,200 scientific abstracts were submitted for the 2015 AANS Annual Scientific Meeting; the scientific presentations accepted for the 2016 event will represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery. Additional information about the 2016 AANS Annual Scientific Meeting and the meeting program can be found here.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 10,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
For more information, visit www.AANS.org.
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