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DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.12320.11

Abstract

Background and Aim: Compound skull fracture accounts for 6% of head injuries. It is usually managed through surgical debridement of devitalized, contaminated soft tissues, fractured segments and dealing the intracranial pathology at the same time. The calvarial defects following debridement are conventionally left behind and cranioplasty is done 2 to 3 month after, to avoid infection related complications. Our aim is to analyze the result of single stage titanium mesh reconstruction in the management of compound and comminuted skull fracture and
review the previous studies.

Method: It is a retrospective study conducted at the VIMSAR, Burla, Sambalpur, odisha where case records of 43 patients of head injury associated with compound skull fracture admitted to neurosurgery department and had undergone debridement, followed by immediate titanium mesh cranioplasty procedure were analyzed between the year 2018 and 2020.The standard technique of debridement was followed in all cases. The presence of depression more than the thickness of surrounding bone, compound nature of the wound, associated dural
injury with or without underlying brain injuries in CT was considered to be the most important criteria for the early debridement. All had undergone cranioplasty. Patients having very low GCS, extensive scalp laceration with skin loss and those having delayed presentation ,post debridement brain swelling were excluded for cranioplasty. All Patients were followed until 3 month after their discharge from ward. The clinico-radiological follow up and outcome was evaluated.

Results: A total of 43 patients were included in the study. Road traffic accident (RTA) was the predominant mechanism of injury (60.5%). The frequency of skull fracture was significantly higher in men (93%) than that in women. The mean Glasgow coma scale was 13.357 at admission and 14.905 at discharge. Fracture was located most commonly in the frontal region (65.11%). 41.9 % of patients had paranasal sinus involvement and 69.8 had associated dural injury. A total of 40 patients achieved good surgical outcome. A very low incidence of complications was found amongst patients during their stay in the hospital and 3 month follow up. One patient developed surgical site infection .one patient had a sinus formation with intermittent discharge needed removal of mesh and two had transient post operative CSF leak. There was no immediate post operative seizure. Post operatively antibiotic was given for average 9 days and the mean hospital stay was 11 days.

Conclusion: Immediate cranioplasty does not pose increased risk of infection as thought earlier. Early and thorough debridement and copious saline irrigation are two most important surgical principles by which infectious complications can be reduced to minimum. So whenever feasible single stage cranioplasty should be preferred over
staged procedure for early overall recovery and return to work.

Keywords: Kull fracture; Cranioplasty; Titanium mesh.
 

Corresponding Author : Acharya Suryakanta Pattajoshi, Assistant Professor, Department of Neurosurgery, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha 768017, India.