demonstrating the safety and efficacy of prophylactic soft-tissue reconstruction with musculocutaneous flaps. These studies advocate muscle flap reconstruction as a primary closure technique for preventing infection in complex spine cases rather than exclusively as a secondary approach for reapproximating a wound after a complication has already occurred. 6–9 , 13 , 14 In June of 2015, our neurosurgery department began to increasingly involve plastic surgery in the primary closure of large spinal wounds believed to be at risk for complication after complex spine tumor
Owen P. Leary, David D. Liu, Michael K. Boyajian, Sohail Syed, Joaquin Q. Camara-Quintana, Tianyi Niu, Konstantina A. Svokos, Joseph Crozier, Adetokunbo A. Oyelese, Paul Y. Liu, Albert S. Woo, Ziya L. Gokaslan and Jared S. Fridley
Celia C. D'Errico, Hamish M. Munro, Steven R. Buchman, Deborah Wagner and Karin M. Muraszko
hematocrit level for patients following transfusion was 35 to 40%. Platelets were transfused for counts less than 10 5 /mm 3 , fresh frozen plasma for prothrombin times longer than 15 seconds and partial thromboplastin times longer than 40 seconds, and cryoprecipitate was given for a fibrinogen level less than 120 mg/dl. The surgeons, who were blinded to the treatment, assessed the appearance of the operative field during the neurosurgical and plastic surgery portions of the procedure. The field was characterized as drier than expected, as expected, or wetter than expected
Jennifer E. Kim, John Pang, Joani M. Christensen, Devin Coon, Patricia L. Zadnik, Jean-Paul Wolinsky, Ziya L. Gokaslan, Ali Bydon, Daniel M. Sciubba, Timothy Witham, Richard J. Redett and Justin M. Sacks
estimated blood loss (EBL), size of the surgical defect, hardware for spinal reconstruction, and types of soft-tissue flap reconstruction were recorded from the plastic surgery and neurosurgery operative notes. Length of hospital stay (LOS) was defined as the time interval from the date of initial surgery to the discharge date of the same hospitalization. Postoperative course was documented from patients' electronic medical records in the discharge summary and at standard follow-up visits. Following surgery, patients were seen at 2 weeks and then at 3, 6, 9, and 12
John K. Houten, Gila R. Weinstein, Michael J. Collins and Daniel Komlos
instillation of doxycycline or clindamycin powder as a sclerosing agent, with the drain remaining in place until drainage was under 30 ml per day, as has been described in the management of seroma formation following body contouring after massive weight loss. 25 The surgical technique was modified during the study period in response to the publication of findings in the plastic surgery literature describing the use of fibrin glue following abdominoplasty and breast surgery to retard seroma formation. 26–28 The study was not designed to capture information about incidence
José Guimarães-Ferreira, Fredrik Gewalli, Pelle Sahlin, Hans Friede, Py Owman-Moll, Robert Olsson and Claes G. K. Lauritzen
Object. Brachycephaly is a characteristic feature of Apert syndrome. Traditional techniques of cranioplasty often fail to produce an acceptable morphological outcome in patients with this condition. In 1996 a new surgical procedure called “dynamic cranioplasty for brachycephaly” (DCB) was reported. The purpose of the present study was to analyze perioperative data and morphological long-term results in patients with the cranial vault deformity of Apert syndrome who were treated with DCB.
Methods. Twelve patients have undergone surgery performed using this technique since its introduction in 1991 (mean duration of follow-up review 60.2 months). Eleven patients had bicoronal synostosis and one had a combined bicoronal—bilambdoid synostosis. Perioperative data and long-term evolution of skull shape visualized on serial cephalometric radiographs were analyzed and compared with normative data. Changes in mean skull proportions were evaluated using a two-tailed paired-samples t-test, with differences being considered significant for probability values less than 0.01.
The mean operative blood transfusion was 136% of estimated red cell mass (ERCM) and the mean postoperative transfusion was 48% of ERCM. The mean operative time was 218 minutes. The duration of stay in the intensive care unit averaged 1.7 days and the mean hospital stay was 11.8 days. There were no incidences of mortality and few complications. An improvement in skull shape was achieved in all cases, with a change in the mean cephalic index from a preoperative value of 90 to a postoperative value of 78 (p = 0.000254).
Conclusions. Dynamic cranioplasty for brachycephaly is a safe procedure, yielding high-quality morphological results in the treatment of brachycephaly in patients with Apert syndrome.
Shokei Yamada, Frederic D. Schuh, J. Shand Harvin and Phanor L. Perot Jr.
% survival at 5 years. Operative morbidity and mortality were still quite high. At the Medical University of South Carolina, we have found that by utilizing a two team approach, en bloc subtotal temporal bone resection can be a safe and effective means for the treatment of advanced cancer of the external ear. The authors would like to describe the details of this operative procedure performed jointly by neurosurgical and plastic surgery teams. Case Reports Case 1 On January 2, 1969, a 51-year-old man was admitted for treatment of drainage from a skin cancer
Michael G. Z. Ghali, Visish M. Srinivasan, Andrew Jea and Sandi Lam
T he history of craniosynostosis surgery is an interesting one and has been well discussed in the recent neurosurgical literature. 30 However, operative intervention for craniosynostosis is not a field exclusive to neurosurgeons, with one of the most important contributors to the development of modern techniques hailing from the field of plastic surgery—Paul Louis Tessier (August 1, 1917–June 6, 2008). To fully appreciate the history and evolution of craniosynostosis surgery, one must understand both Tessier's direct contributions to this condition proper
Nicholas A. Pickersgill, Gary B. Skolnick, Sybill D. Naidoo, Matthew D. Smyth and Kamlesh B. Patel
Metrics used to quantify preoperative severity and postoperative outcomes for patients with sagittal synostosis include cephalic index (CI), the well-known standard, and the recently described adjusted cephalic index (aCI), which accounts for altered euryon location. This study tracks the time course of these measures following endoscopic repair with orthotic helmet therapy. The authors hypothesize that CI and aCI show significant regression following endoscope-assisted repair.
CT scans or 3D photographs of patients with nonsyndromic sagittal synostosis treated before 6 months of age by endoscope-assisted strip craniectomy and postoperative helmet therapy (n = 41) were reviewed retrospectively at three time points (preoperatively, 0–2 months after helmeting, and > 24 months postoperatively). The CI and aCI were measured at each time point.
Mean CI and aCI increased from 71.8 to 78.2 and 62.7 to 72.4, respectively, during helmet treatment (p < 0.001). At final follow-up, mean CI and aCI had regressed significantly from 78.2 to 76.5 and 72.4 to 69.7, respectively (p < 0.001). The CI regressed in 33 of 41 cases (80%) and aCI in 39 of 41 cases (95%). The authors observed a mean loss of 31% of improvement in aCI achieved through treatment. A strong, positive correlation existed between CI and aCI (R = 0.88).
Regression following endoscope-assisted strip craniectomy with postoperative helmet therapy commonly occurs in patients with sagittal synostosis. Future studies are required to determine whether duration of helmet therapy or modifications in helmet design affect regression.
Tufan Hicdonmez, Turgay Parsak and Sebahattin Cobanoglu
live animal models; it should serve only as a complementary training model for surgeons new to craniosynostosis surgery. Conclusions This model in fresh cadaveric sheep crania, besides being inexpensive, represents a fairly useful simulation method through which neurosurgery and plastic surgery residents can become accustomed to performing the basic steps in surgical correction of craniosynostosis. References 1 Aboud E , Al-Mefty O , Yaşargil MG : New laboratory model for neurosurgical training that simulates live surgery . J Neurosurg 97
Paul MacMahon, Stanca Iacob, Sarah E. Bach, Eric T. Elwood, Julian J. Lin and Anthony M. Avellino
extraaxial mass ( arrow ). D and E: Sagittal noncontrast (D) and with contrast (E) T1-weighted MR images showing the extraaxial mass ( arrows ). F: Sagittal noncontrast T1-weighted MR image showing the near-complete agenesis of the corpus callosum with an associated midline lipoma ( arrow ). Operation A multidisciplinary plastic surgery and neurosurgery team performed the surgery. The patient underwent concurrent resection of the nasal polypoid lesion, the intracranial intradural cystic lesion, and their interconnecting tract ( Fig. 1B and C ). Operatively, the patient