Anterior skull base reconstruction after tumour resection using the posterior wall of the frontal sinus.

INTRODUCTION: The authors describe their experience of surgical closure of the anterior skull base after tumour resection, using the posterior wall of the frontal sinus. MATERIAL AND METHOD: The authors describe their anterior skull base closure technique performed in three patients after tumour resection. Tumour resection via a transglabellar approach resulted in an anterior skull base defect. Reconstruction consisted of direct implantation of the posterior wall of the frontal sinus without using a bone substitute (except when nasofrontal duct obstruction is required). RESULTS: Three patients were operated by this surgical procedure with complete tumour resection in every case and no infectious complications. This technique was easy to perform, despite one case of persistent CSF leak. Follow-up imaging showed no displacement of the onlay bone graft. CONCLUSION: Anterior skull base reconstruction after tumour resection using autologous frontal sinus bone graft is easy to perform with a low complication rate.

Reconstruction of cranioplasty using medpor porouspolyethylene implant.

INTRODUCTION: We describe our experience of cranioplasty after a calvarial defect, following an external decompressive craniectomy, with the Medpor® (Stryker®) porous polyethylene implant for cosmetic cranioplasty and reconstruction. METHODS: A retrospective chart review was performed on 23 consecutive patients who underwent cranioplasty at a single institution between January 2013 and January 2016: 9 patients after head injury and 14 patients after vascular event (ruptured aneurysm, intraprenchymal haematoma, malignant cerebrovascular accident). All patients with cranioplasties after oncological resection or infection were excluded. These cranioplasties were performed using porous polyethylene sheet (Medpor®) and contoured with a burr or scissors in the sterile field, and fixed to the calvarial bone with screws. RESULTS: Porous polyethylene sheet (Medpor®) is a proven material used for cranial reconstruction in neurosurgery and maxillofacial surgery with a biocompatibility advantage. The implant can be directly used in an emergency context. The average operating time was 72minutes. An average delay of 527 days (1 year and 5months) with a median of 985 days (43; 4206) occurred between craniectomy and the cranioplasty. There was only one set back implant due to scalp necrosis with infection for a recovery-unit patient. CONCLUSION: Porous polyethylene is an excellent restorative material for the reconstruction of large sized cranial defects and can be also used safely in reconstruction of the cranium. The cosmetic results are good, easy to perform, with a low complication rate.

Is spinal cord stimulation safe? A review of 13 years of implantations and complications.

OBJECTIVE: The aim of this review was to evaluate the complications of spinal cord stimulation (SCS) for chronic pain. METHODS: This was a retrospective case series of 212 patients treated with SCS for chronic lower-limb neuropathic pain between March 2002 and February 2015 in a Reims academic hospital. All patients received a surgically implanted paddle-type electrode. Complications with this technique are here described and analyzed, and other treatment and preventative methods proposed. RESULTS: The major indication was 'failed back surgery syndrome', and 74 (35%) patients experienced complications, of which 57% were benign, while 42% required invasive treatment. Most frequent complications (n=22, 10%) were hardware malfunctions. There were two cases (0.9%) of postoperative neurological deficit and nine (4.2%) with postoperative infections. All patients received the appropriate treatment for their complication. CONCLUSION: Despite the presence of complications, SCS is still a safe technique, although careful patient selection and proper surgical technique can help to avoid major complications.

Ectopic bone formation with joint impingement after posterior lumbar fusion with rhBMP-2.

Recombinant human bone morphogenetic protein-2 (rhBMP-2) was recently licensed for local administration during posterior lumbar fusion. In this indication, considerable uncertainty remains about the nature and mechanisms of the many adverse effects of rhBMP-2, such as ectopic bone formation. We report a case of ectopic bone formation with impingement on a facet joint and incapacitating low back pain after minimally invasive transforaminal L5-S1 interbody fusion with local application of rhBMP-2 (InductOs(®)). Revision surgery was eventually performed to alleviate the symptoms by removing the ectopic bone. Caution is in order regarding the use of rhBMP-2 during posterior lumbar fusion. Every effort should be made to minimise the risk of complications.