Clinical neurology and neurosurgery · 2025
Optimal timing of cerebrospinal fluid shunting in patients needing cranioplasty.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Urvas Netta, Korhonen Tommi K, Tetri Sami, Mee Harry, Whiting Gemma, Viaroli Edoardo, Kolias Angelos, Timofeev Ivan, Helmy Adel, Hutchinson Peter
Аннотация
BACKGROUND: Cranioplasty is performed to repair the cranium after injury or surgery. Cerebrospinal fluid shunts are commonly required to treat associated hydrocephalus. Single-stage shunt and cranioplasty surgery have been associated with increased risks compared with a staged approach. We aimed to assess whether the timing of cerebrospinal fluid (CSF) shunting (pre- or post-cranioplasty) affects complication rates.
METHODS: We retrospectively identified all cranioplasty procedures conducted between 11/2017-12/2021 and 1/2004-3/2022 from the Cambridge and Oulu University Hospitals, respectively. The primary and secondary outcomes were implant removal and complications, respectively.
RESULTS: Four-hundred-and-thirty-three cranioplasties were performed in 379 patients. Sixty-eight (16 %) cranioplasties were performed in patients requiring a shunt. Forty-three (63 %) shunts were inserted before, three (4 %) during, and 22 (32 %) after cranioplasty. Overall complication rates excluding hydrocephalus were 47 % and 41 % among those shunted before and after cranioplasty, respectively (OR 0,74, 95 % CI 0,24-2,28). SSIs (26 % vs. 18 %) and CSF leaks (7 % vs. 0 %) were slightly more common among those shunted before cranioplasty compared to those shunted after cranioplasty, respectively, but rates of post-operative haematomas were similar (5 % vs. 5 %, respectively). Overall implant removal rates were statistically similar between patients with shunts cited pre-cranioplasty and those with shunts cited after cranioplasty (26 % vs. 32 %, respectively, OR 1,26, 95 % CI 0,44-3,55).
CONCLUSION: Although patients who underwent CSF shunting before cranioplasty had 6 % more complications than those who had been shunted after cranioplasty, those shunted after cranioplasty had 6 % more implant failures. Delaying CSF shunt insertion after cranioplasty should be preferable, not least because CSF absorption can improve on cranioplasty insertion. Single-stage surgery should be avoided.
METHODS: We retrospectively identified all cranioplasty procedures conducted between 11/2017-12/2021 and 1/2004-3/2022 from the Cambridge and Oulu University Hospitals, respectively. The primary and secondary outcomes were implant removal and complications, respectively.
RESULTS: Four-hundred-and-thirty-three cranioplasties were performed in 379 patients. Sixty-eight (16 %) cranioplasties were performed in patients requiring a shunt. Forty-three (63 %) shunts were inserted before, three (4 %) during, and 22 (32 %) after cranioplasty. Overall complication rates excluding hydrocephalus were 47 % and 41 % among those shunted before and after cranioplasty, respectively (OR 0,74, 95 % CI 0,24-2,28). SSIs (26 % vs. 18 %) and CSF leaks (7 % vs. 0 %) were slightly more common among those shunted before cranioplasty compared to those shunted after cranioplasty, respectively, but rates of post-operative haematomas were similar (5 % vs. 5 %, respectively). Overall implant removal rates were statistically similar between patients with shunts cited pre-cranioplasty and those with shunts cited after cranioplasty (26 % vs. 32 %, respectively, OR 1,26, 95 % CI 0,44-3,55).
CONCLUSION: Although patients who underwent CSF shunting before cranioplasty had 6 % more complications than those who had been shunted after cranioplasty, those shunted after cranioplasty had 6 % more implant failures. Delaying CSF shunt insertion after cranioplasty should be preferable, not least because CSF absorption can improve on cranioplasty insertion. Single-stage surgery should be avoided.