Optimal timing of cerebrospinal fluid shunting in patients needing cranioplasty

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-03-24 DOI:10.1016/j.clineuro.2025.108863

Netta Urvas , Tommi K. Korhonen , Sami Tetri , Harry Mee , Gemma Whiting , Edoardo Viaroli , Angelos Kolias , Ivan Timofeev , Adel Helmy , Peter Hutchinson

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Abstract

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.

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颅成形术患者脑脊液分流的最佳时机

颅成形术是在颅脑损伤或手术后进行修复。脑脊液分流术通常用于治疗相关脑积水。与分阶段入路相比，单阶段分流术和颅骨成形术的风险增加。我们的目的是评估脑脊液（CSF）分流的时机（颅骨成形术前或术后）是否影响并发症发生率。方法回顾性分析2017年11月至2021年12月至2004年1月至2022年3月期间在剑桥大学医院和奥卢大学医院进行的所有颅骨成形术。主要和次要结果分别是种植体移除和并发症。结果379例患者共行433例颅骨成形术。68例（16% %）颅骨成形术用于需要分流术的患者。在颅骨成形术前置入43例（63 %）分流管，在颅骨成形术中置入3例（4 %），在颅骨成形术后置入22例（32 %）分流管。在颅骨成形术前后分流的患者中，除脑积水外的总并发症发生率分别为47 %和41 % （OR 0,74, 95 % CI 0,24 - 2,28）。与颅骨成形术后分流的患者相比，颅骨成形术前分流的患者ssi（26. %对18. %）和脑脊液泄漏（7. %对0. %）略高于颅骨成形术后分流的患者，但术后血肿的发生率相似（分别为5. %对5. %）。颅成形术前分流术患者和颅成形术后分流术患者的整体种植体移除率在统计学上相似（分别为26 %和32 %，OR 1,26, 95 %,CI 0,44 - 3,55）。结论颅成形术前行脑脊液分流术的患者并发症发生率比颅成形术后行脑脊液分流术的患者高6 %，而颅成形术后行脑脊液分流术的患者植入失败发生率高6 %。颅成形术后延迟脑脊液分流器的插入是可取的，尤其是因为脑脊液的吸收可以改善颅成形术的插入。应避免单阶段手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.