J Korean Neurosurg Soc.  2014 Nov;56(5):410-418. 10.3340/jkns.2014.56.5.410.

Clinical Analysis of Epidural Fluid Collection as a Complication after Cranioplasty

• Kim SP
• Kang DS
• Cheong JH
• Kim JH
• Song KY
• Kong MH

• KMID: 2018100
• DOI: http://doi.org/10.3340/jkns.2014.56.5.410

Abstract

OBJECTIVE
The epidural fluid collection (EFC) as a complication of cranioplasty is not well-described in the literature. This study aimed to identify the predictive factors for the development of EFC as a complication of cranioplasty, and its outcomes.
METHODS
From January 2004 to December 2012, 117 cranioplasty were performed in our institution. One-hundred-and-six of these patients were classified as either having EFC, or not having EFC. The two groups were compared to identify risk factors for EFC. Statistical significance was tested using the t-test and chi-square test, and a logistic regression analysis.
RESULTS
Of the 117 patients undergoing cranioplasty, 59 (50.4%) suffered complications, and EFC occurred in 48 of the patients (41.0%). In the t-test and chi-test, risk factors for EFC were size of the skull defect (p=0.003) and postoperative air bubbles in the epidural space (p<0.001). In a logistic regression, the only statistically significant factor associated with development of EFC was the presence of postoperative air bubbles. The EFC disappeared or regressed over time in 30 of the 48 patients (62.5%), as shown by follow-up brain computed tomographic scan, but 17 patients (35.4%) required reoperation.
CONCLUSION
EFC after cranioplasty is predicted by postoperative air bubbles in the epidural space. Most EFC can be treated conservatively. However, reoperation is necessary to resolve about a third of the cases. During cranioplasty, special attention is required when the skull defect is large, since EFC is then more likely.

Keyword

Cranioplasty; Epidural fluid collection; Size of skull defect

MeSH Terms

Brain
Epidural Space
Follow-Up Studies
Humans
Logistic Models
Reoperation
Risk Factors
Skull

Figure

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  Fig. 1 Computed tomography scans showing postoperative air bubbles in the epidural space (A) and epidural fluid collection at postoperative 10 days (B).

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  Fig. 2 Computed tomography scans show epidural fluid collection in three different patients with ventriculoperitonral shunt (A and B), with extensive cerebromalacia (C and D), and with severe depression at craniectomy site (E and F).

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  Fig. 3 Computed tomography scans after cranioplasty showing three different types based on amount of epidural fluid collection. A : Minimal. Brain compression without midline shift. B : Moderate. Brain compression with a little midline shift. C : Extensive. Brain compression with definite midline shift.

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