Sonolucent cranioplasty in extracranial to intracranial bypass surgery: Early multicenter experience of 44 cases

Authors

Mohamed M. Salem, Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
Krishnan Ravindran, Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.
Alex Nguyen Hoang, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Omer Doron, Department of Neurosurgery, Lenox Hill Hospital, New York City, New York, USA.
Rogelio Esparza, Department of Neurosurgery, New York University School of Medicine, New York, New York, USA.
Daniel Raper, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Brian T. Jankowitz, Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
Omar Tanweer, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Demetrius Lopes, Advocate Aurora HealthFollow
David Langer, Department of Neurosurgery, Lenox Hill Hospital, New York City, New York, USA.
Erez Nossek, Department of Neurosurgery, New York University School of Medicine, New York, New York, USA.
Jan-Karl Burkhardt, Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.

Recommended Citation

Salem MM, Ravindran K, Hoang AN, et al. Sonolucent Cranioplasty in Extracranial to Intracranial Bypass Surgery: Early Multicenter Experience of 44 Cases. Oper Neurosurg (Hagerstown). 2023;25(1):20-27. doi:10.1227/ons.0000000000000674

Abstract

Background: The new sonolucent cranioplasty implant (clear polymethyl methacrylate, PMMA) adds functionality besides surgical reconstruction. One possible application uses the transcranioplasty ultrasound (TCUS) technique after PMMA cranioplasty to assess graft patency of extracranial-intracranial (EC-IC) bypass procedures.

Objective: To report our early multicenter experience.

Methods: This is a multicenter analysis of consecutive EC-IC bypass patients from 5 US centers (2019-2022) with closure postbypass using PMMA implant.

Results: Forty-four patients (median age 53 years, 68.2% females) were included. The most common indication for bypass was Moyamoya disease/syndrome (77.3%), and superficial temporal artery to middle cerebral artery bypass was the most common procedure (79.5%). Pretreatment modified Rankin Scales of 0 and 1 to 2 were noted in 11.4% and 59.1% of patients, respectively. Intraoperative imaging for bypass patency involved a combination of modalities; Doppler was the most used modality (90.9%) followed by indocyanine green and catheter angiography (86.4% and 61.4%, respectively). Qualitative TCUS assessment of graft patency was feasible in all cases. Postoperative inpatient TCUS confirmation of bypass patency was recorded in 56.8% of the cases, and outpatient TCUS surveillance was recorded in 47.7%. There were no cases of bypass failure necessitating retreatment. Similarly, no implant-related complications were encountered in the cohort. Major complications requiring additional surgery occurred in 2 patients (4.6%) including epidural hematoma requiring evacuation (2.3%) and postoperative surgical site infection (2.3%) that was believed to be unrelated to the implant.

Conclusion: This multicenter study supports safety and feasibility of using sonolucent PMMA implant in EC-IC bypass surgery with the goal of monitoring bypass patency using TCUS.

Document Type

Article

PubMed ID

36929760