Outcome in patient-specific PEEK cranioplasty: A two-center cohort study of 40 implants.

OBJECTIVE: The best material choice for cranioplasty following craniectomy remains a subject to discussion. Complication rates after cranioplasty tend to be high. Computer-assisted 3-dimensional modelling of polyetheretherketone (PEEK) was recently introduced for cranial reconstruction. The aim of this study was to evaluate patient- and surgery-related characteristics and risk factors that predispose patients to cranioplasty complications. MATERIAL AND METHODS: This retrospective study included a total of 40 cranial PEEK implants in 38 patients, performed at two reference centers in the Netherlands from 2011 to 2014. Complications were registered and patient- and surgery-related data were carefully analysed. RESULTS: The overall complication rate of PEEK cranioplasty was 28%. Complications included infection (13 %), postoperative haematoma (10 %), cerebrospinal fluid leak (2.5 %) and wound-related problems (2.5 %). All postoperative infections required removal of the implant. Nonetheless removed implants could be successfully re-used after re-sterilization. CONCLUSION: Although overall complication rates after PEEK cranioplasty remain high, outcomes are satisfactory, as our results compare favourably to recent literature reports on cranial vault reconstruction.

Surgical morbidity and mortality of pediatric brain tumors: a single center audit.

OBJECTIVES: The primary aim of this study is to perform an internal quality control of pediatric brain tumor surgery in the neurosurgical department of the VU University Medical Center Amsterdam (The Netherlands). Secondly, this study aims to contribute to the accumulating data concerning outcome in pediatric neurosurgery, in order to establish institutional practice benchmarks. METHODS: We report the surgical mortality and morbidity of 121 patients (0-18 years) surgically treated for a brain tumor from January 1999 to August 2007. Patients, in whom only a brain tumor biopsy was performed, were excluded. RESULTS: Mean age at first surgery was 8.2 years. Of the 121 patients, 14 had a second surgery, and two underwent a third surgery (for a total of 137 operations). Of all 121 primary surgeries, 66% were total resections, 26% subtotal resections, and 8% partial resections. The overall surgical morbidity rate in this study was 69% after first surgery, 50% after second surgery, and one out of two after third surgery. CONCLUSION: These overall morbidity rates are comparable to other published mixed case series. The surgical mortality rate was 0.8%; this is comparable to the lowest rates reported for high-volume neurosurgical centers. We encourage other neurosurgical centers to collect, analyze, and publish their data. These data can then serve as a basis for comparison with other pediatric neurosurgical centers and will eventually lead to an improvement of pediatric neurosurgical practice and patient care.

[Neuromonitoring of patients following severe brain trauma]. / Neuromonitoring bij patiënten na ernstig traumatisch hersenletsel.

To a considerable extent, the neurological outcome of patients with severe brain trauma is determined by the primary injury caused by the accident. Substantial progress has been made in our understanding of the pathophysiological processes resulting in secondary brain damage after brain trauma, partly as a result of the introduction of advanced techniques of neuromonitoring. Early recognition and treatment of the symptoms leading to this type of brain damage seems crucial to the effort to improve the neurological outcome in these patients. Useful modern neuromonitoring techniques include: measurement of the intracranial and cerebral perfusion pressure and continuous electroencephalography. Methods that are also reliable and readily applicable, but less relevant clinically, include cerebral microdialysis of fluid from the extracellular space, determination of the parenchymal oxygen tension, and determination of the venous oxygen saturation. Other techniques that are not clinically applicable include: determination of the cerebral blood flow, the cortical tissue perfusion or the regional cerebral oxygenation.

Follow-up of 13 patients with surgical treatment of cerebral cavernous malformations: effect on epilepsy and patient disability.

OBJECTIVE: We report a series of 13 patients with surgical treatment of cerebral cavernous malformation (CM). The aim of this study was to investigate postoperative patient disability and seizure control in patients with CM in order to clarify indications for neurosurgical removal. In our series we emphasize the beneficial effect of excision of CMs. We also give an overview of the current literature covering options for treatment in surgically inaccessible CMs. METHODS: In this retrospective study we describe the clinical outcomes of neurosurgical intervention in 13 patients with a CM. Seven patients had epilepsy at presentation and six had focal neurological deficits due to intracerebral haemorrhage (five patients) or mass effect due to the CM (one patient). The modified Rankin scale was used to define patient disability pre- and postoperatively. An overview of the indications for surgery and postoperative outcome with follow up periods of 1-6 years (mean: 3.3 years) are provided. RESULTS: In all patients presenting with epilepsy a reduction in seizure frequency was seen. Four of them became seizure-free postoperatively. The six patients with neurological deficits due to intracerebral haemorrhage or mass effect due to the CM showed clinical improvement postoperatively, two of them made full recoveries. Improvement of the postoperative Rankin score was seen in six of 13 patients. CONCLUSION: Improvement in seizure control and reduction in patient disability warrants surgical intervention in symptomatic CMs.