Removal of symptomatic titanium fixation plates after craniotomy

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Biomaterials Science

Background:

• Titanium fixation plates are standard for bone flap stabilization post-craniotomy.
• Plate removal is occasionally necessary for complications like infection, pain, or protrusion, especially after craniofacial or orbitozygomatic procedures.
• Plate removal for pain and protrusion after standard craniotomy without orbitozygomatic osteotomy is infrequently documented.

Purpose of the Study:

• To report the incidence and outcomes of cranial fixation plate removal due to pain and protrusion in patients undergoing craniotomy without orbitozygomatic osteotomy.
• To highlight a potential surgical modification to mitigate these complications.

Main Methods:

• A retrospective analysis of patients undergoing cranial fixation plate removal after craniotomy was conducted.
• Data from 2014-2016 at a single institution were reviewed.
• Nine patients with plate removal for pain and protrusion were identified.

Main Results:

• Out of 319 patients with plate fixation, 1.6% (five patients) required plate removal for pain and protrusion.
• An additional four patients had plates removed for similar reasons, with prior craniotomies predating the study period.
• All nine patients reported immediate symptom resolution following plate removal.

Conclusions:

• Cranial fixation plate removal for pain and protrusion can be necessary even in craniotomies without orbitozygomatic osteotomy, particularly frontotemporal approaches.
• Eliminating the need for a titanium burr hole cover plate in the keyhole area of frontotemporal craniotomies may reduce complication rates.