J Korean Neurosurg Soc.  2020 Sep;63(5):631-639. 10.3340/jkns.2019.0181.

Single-Stage Reconstruction with Titanium Mesh for Compound Comminuted Depressed Skull Fracture

• Eom KS

• KMID: 2506027
• DOI: http://doi.org/10.3340/jkns.2019.0181

Abstract

Objective
: Traditionally, staged surgery has been preferred in the treatment of compound comminuted depressed fracture (FCCD) after traumatic brain injury (TBI) and involves the removal of primarily damaged bone and subsequent cranioplasty. The main reason for delayed cranioplasty was to reduce the risk of infection-related complications. Here, the author performed immediate reconstruction using a titanium mesh in consecutive patients with FCCD after TBI, reported the surgical results, and reviewed previous studies.
Methods
: Nineteen consecutive patients who underwent single-stage reconstruction with titanium mesh for FCCD of the skull from April 2014 to June 2018 were retrospectively analyzed. The demographic and radiological characteristics of the patients with FCCD were investigated. The characteristics associated with surgery and outcome were also evaluated.
Results
: The frequency of TBI in men (94.7%) was significantly higher than that in women. Most FCCDs (73.7%) occurred during work, the rest were caused by traffic accidents. The mean interval between TBI and surgery was 7.0±3.9 hours. The median Glasgow coma scale score was 15 (range, 8–15) at admission and 15 (range, 10–15) at discharge. FCCD was frequently located in the frontal (57.9%) and parietal (31.6%) bones than in other regions. Of the patients with FCCDs in the frontal bone, 62.5% had paranasal sinus injury. There were five patients with fractures of orbital bone, and they were easily reconstructed using titanium mesh. These patients were cosmetically satisfied. Postoperatively, antibiotics were used for an average of 12.6 days. The mean hospital stay was 17.6±7.5 days (range, 8–33). There was no postoperative seizure or complications, such as infection.
Conclusion
: Immediate bony fragments replacement and reconstruction with reconstruction titanium mesh for FCCD did not increase infectious sequelae, even though FCCD involved sinus. This suggests that immediate single-stage reconstruction with titanium mesh for FCCD is a suitable surgical option with potential benefits in terms of cost-effectiveness, safety, and cosmetic and psychological outcomes.

Keyword

Fractures; Comminuted; Brain injuries; Traumatic; Cranioplasty; Infections.

Figure

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  Fig. 1. A-C : Preoperative cranial computed tomography showing the comminuted depressed fractures of the right frontal bone, a Le Fort type I and III comminuted fracture of the midfacial bones, and traumatic intracranial hematoma in the right frontal lobe with pneumocephalus.

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  Fig. 2. A-C : Postoperative cranial computed tomography showing that fragmented bones and hematoma were removed, and the bony defect was reconstructed using titanium mesh and microscrews.

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  Fig. 3. A-C : Cranial computed tomography after 4 months showing well-fixed titanium mesh along the periphery of the bony defect without additional abnormality.

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  Fig. 4. Preoperative and postoperative cranial CT of patients with fractures of orbital bone. CT : computed tomography.

Reference

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