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The diagnosis of infections associated with acrylic cranioplasties
E C Benzel1, K Thammavaram, L Kesterson
1University of New Mexico, School of Medicine, Division of Neurosurgery, Albuquerque.
Abstract:
Fifty-two methylmethacrylate cranioplasties were performed on forty-seven patients over a five year period. Two cranioplasties became infected and required removal. The overall infection rate for methylmethacrylate cranioplasty was thus 2/52 or 3.8%. Both of these patients had bifrontal cranioplasties involving both orbital rims and the frontal sinus. The infection rate for those cranioplasties involving the frontal sinus was 2 of 9 or 22%. None of the 43 cranioplasties not involving the frontal sinus became infected. Ten patients in this series had postoperative CT scans. Gas within the non-infected methylmethacrylate could simulate infection, making it difficult to diagnose cranioplasty infections by CT. Although certain CT changes, such as epidural air and soft tissue swelling, may be observed only with infected cranioplasties, the clinical picture is the only truly reliable indicator of infection.
Insights
Methylmethacrylate cranioplasty infection rates are low overall (3.8%). However, cranioplasties involving the frontal sinus have a significantly higher infection risk (22%), necessitating careful clinical evaluation.
Area of Science:
- Neurosurgery
- Biomaterials Science
Background:
- Methylmethacrylate cranioplasty is a common procedure for skull reconstruction.
- Understanding infection risks associated with this biomaterial is crucial for patient outcomes.
Observation:
- A series of 52 methylmethacrylate cranioplasties were analyzed over five years.
- Two infections occurred, both in patients with bifrontal cranioplasties involving the frontal sinus.
Findings:
- The overall infection rate was 3.8% (2/52).
- Cranioplasties involving the frontal sinus had a markedly higher infection rate of 22% (2/9).
- No infections were observed in cranioplasties not involving the frontal sinus (0/43).
Implications:
- Cranioplasties incorporating the frontal sinus present a significantly elevated risk of infection.
- Computed tomography (CT) findings can be ambiguous due to gas within the methylmethacrylate, potentially mimicking infection.
- Clinical assessment remains the most reliable method for diagnosing methylmethacrylate cranioplasty infections.