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Analysis of craniectomy bone flaps stored in a neurosurgical cryopreservation freezer: microorganism culture results and reimplantation rates

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Abstract

Background

Cryopreservation of bone flaps after decompressive craniectomies is a common practice. A frequent complication after bone flap reimplantation is postoperative infection, so culturing of frozen craniectomy bone flaps is a crucial practice that can prevent patient morbidity and mortality. Although many studies report on infection rates after cranioplasty, no study reports on the results of bone flaps stored in a cryopreservation freezer, reimplanted or otherwise. We sought to analyze the flaps in our medical center’s bone bank freezer, including microorganism culture results and reimplantation rates of cryopreserved bone flaps.

Methods

Patients who underwent craniectomy and had bone flaps cryopreserved between January 1, 2016, and July 1, 2022, were included in this retrospective study. Information about bone flap cultures and reimplantation or discard was obtained from a prospectively maintained cryopreservation database. Information including infection rates and mortality was acquired from a retrospective review of patient records. Culture results were obtained for all flaps immediately before cryopreservation and again at the time of reimplantation at the operator’s discretion.

Results

There were 148 bone flaps obtained from 145 patients (3 craniectomies were bilateral) stored in our center’s freezer. Positive culture results were seen in 79 (53.4%) flaps. The most common microorganism genus was Propionibacterium with 47 positive flaps, 46 (97.9%) of which were P. acnes. Staphylococcus was the second most common with 23 positive flaps, of which 8 (34.8%) tested positive for S. epidermidis. Of the 148 flaps, 25 (16.9%) were reimplanted, 116 (78.4%) were discarded, and 7 (4.7%) are still being stored in the freezer. Postcranioplasty infections were seen in 3 (12%) patients who had flap reimplantation.

Conclusions

Considering the substantial number of positive cultures and limited reimplantation rate, we have reservations about the logistical efficiency of cryopreservation for flap storage. Future multicenter studies analyzing reimplantation predictors could help to reduce unnecessary freezing and culturing.

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Abbreviations

IQR:

Interquartile range

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

USD:

United States dollar(s)

References

  1. Abbott KH (1953) Use of frozen cranial bone flaps for autogenous and homologous grafts in cranioplasty and spinal interbody fusion. J Neurosurg 10:380–388

    Article  CAS  PubMed  Google Scholar 

  2. Acikgoz B, Ozcan OE, Erbengi A, Bertan V, Ruacan S, Acikgoz HG (1986) Histopathologic and microdensitometric analysis of craniotomy bone flaps preserved between abdominal fat and muscle. Surg Neurol 26:557–561

    Article  CAS  PubMed  Google Scholar 

  3. Bhaskar IP, Zaw NN, Zheng M, Lee GY (2011) Bone flap storage following craniectomy: a survey of practices in major Australian neurosurgical centres. ANZ J Surg 81:137–141

    Article  PubMed  Google Scholar 

  4. Binhammer A, Jakubowski J, Antonyshyn O, Binhammer P (2020) Comparative cost-effectiveness of cranioplasty implants. Plast Surg (Oakv) 28:29–39

    Article  PubMed  Google Scholar 

  5. Bruce JN, Bruce SS (2003) Preservation of bone flaps in patients with postcraniotomy infections. J Neurosurg 98:1203–1207

    Article  PubMed  Google Scholar 

  6. Chiang HY, Steelman VM, Pottinger JM, Schlueter AJ, Diekema DJ, Greenlee JD, Howard MA 3rd, Herwaldt LA (2011) Clinical significance of positive cranial bone flap cultures and associated risk of surgical site infection after craniotomies or craniectomies. J Neurosurg 114:1746–1754

    Article  PubMed  Google Scholar 

  7. Dowlati E, Pasko KBD, Molina EA, Felbaum DR, Mason RB, Mai JC, Nair MN, Aulisi EF, Armonda RA (2022) Decompressive hemicraniectomy and cranioplasty using subcutaneously preserved autologous bone flaps versus synthetic implants: perioperative outcomes and cost analysis. J Neurosurg 137:1831–1838

    Article  PubMed  Google Scholar 

  8. Giese H, Meyer J, Unterberg A, Beynon C (2021) Long-term complications and implant survival rates after cranioplastic surgery: a single-center study of 392 patients. Neurosurg Rev 44:1755–1763

    Article  PubMed  Google Scholar 

  9. Gooch MR, Gin GE, Kenning TJ, German JW (2009) Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 26:E9

    Article  PubMed  Google Scholar 

  10. Grossman N, Shemesh-Jan HS, Merkin V, Gideon M, Cohen A (2007) Deep-freeze preservation of cranial bones for future cranioplasty: nine years of experience in Soroka University Medical Center. Cell Tissue Bank 8:243–246

    Article  CAS  PubMed  Google Scholar 

  11. Melin S, Haase I, Nilsson M, Claesson C, Ostholm Balkhed A, Tobieson L (2022) Cryopreservation of autologous bone flaps following decompressive craniectomy: a new method reduced positive cultures without increase in post-cranioplasty infection rate. Brain Spine 2:100919

    Article  PubMed  PubMed Central  Google Scholar 

  12. Morton RP, Abecassis IJ, Hanson JF, Barber J, Nerva JD, Emerson SN, Ene CI, Chowdhary MM, Levitt MR, Ko AL, Dellit TH, Chesnut RM (2016) Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps. J Neurosurg 125:766–770

    Article  PubMed  Google Scholar 

  13. Nakajima T, Someda K, Yamanouchi Y, Matsumura H (1977) Subcutaneous preservation of free skull bone flap taken out in decompressive craniectomy– a follow-up study. No Shinkei Geka 5:1329–1333

    CAS  PubMed  Google Scholar 

  14. Odom GL, Woodhall B, Wrenn FR (1952) The use of refrigerated autogenous bone flaps for cranioplasty. J Neurosurg 9:606–610

    Article  CAS  PubMed  Google Scholar 

  15. Stieglitz LH, Fung C, Murek M, Fichtner J, Raabe A, Beck J (2015) What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients. Acta Neurochir (Wien) 157:275–280

    Article  PubMed  Google Scholar 

  16. Zanaty M, Chalouhi N, Starke RM, Clark SW, Bovenzi CD, Saigh M, Schwartz E, Kunkel ES, Efthimiadis-Budike AS, Jabbour P, Dalyai R, Rosenwasser RH, Tjoumakaris SI (2015) Complications following cranioplasty: incidence and predictors in 348 cases. J Neurosurg 123:182–188

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Debra J. Zimmer for editorial assistance.

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Authors and Affiliations

  1. Department of Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA

    Brianna M. Donnelly, David E. Smolar, Ammad A. Baig, Mohamed A. R. Soliman, Andre Monteiro, Kevin J. Gibbons, Elad I. Levy & Kenneth V. Snyder

  2. Department of Neurosurgery, Buffalo General Medical Center and Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA

    Brianna M. Donnelly, David E. Smolar, Ammad A. Baig, Mohamed A. R. Soliman, Andre Monteiro, Kevin J. Gibbons, Elad I. Levy & Kenneth V. Snyder

  3. Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed A. R. Soliman

  4. Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Elad I. Levy

  5. Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Elad I. Levy & Kenneth V. Snyder

  6. Jacobs Institute, Buffalo, NY, USA

    Elad I. Levy & Kenneth V. Snyder

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  1. Brianna M. Donnelly
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Contributions

Conception and design: BMD and DES. Acquisition of the data: BMD, DES, and KJG. Analysis and interpretation of the data: all the authors. Drafting the manuscript: BMD, DES, AAB, and AM. Critically revising the manuscript: all the authors. Reviewed submitted version of the manuscript: all the authors.

Corresponding author

Correspondence to Kenneth V. Snyder.

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Ethical approval

All the procedures involving human participants were performed in accordance with the ethical standards of the University at Buffalo Institutional Review Board (STUDY00006706) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Disclosure of financial relationships

BMD, DES, AAB, AM, MARS, and KJG: None. EIL: shareholder/ownership interest: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, and Three Rivers Medical; Patent: bone scalpel; honorarium for training & lectures: Medtronic, Penumbra, MicroVention, Integra, and Consultant: Clarion, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, StimMed, Misonix, and Mosiac; Chief Medical Officer: Haniva Technology; National PI: Medtronic — Steering Committees for SWIFT Prime and SWIFT Direct Trials; Site PI Study: MicroVention (CONFIDENCE Study) Medtronic (STRATIS Study-Sub 1); Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical; Endostream Medical, IRRAS AB. Consultant/Advisory Board, and Medical Legal Review: render medical/legal opinions as an expert witness; leadership or fiduciary roles in other board society, committee or advocacy group, paid and unpaid: CNS, ABNS, and UBNS. KVS: consulting fees: Boston Scientific, Canon Medical Systems USA, Inc., MicroVention, Medtronic, Stryker Neurovascular. Payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational event: Canon Medical Systems USA Inc. Stock or stock options: Boston Scientific, Access Closure Inc., and Niagara Gorge Medical.

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Donnelly, B.M., Smolar, D.E., Baig, A.A. et al. Analysis of craniectomy bone flaps stored in a neurosurgical cryopreservation freezer: microorganism culture results and reimplantation rates. Acta Neurochir 165, 3187–3195 (2023). https://doi.org/10.1007/s00701-023-05764-7

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  • DOI: https://doi.org/10.1007/s00701-023-05764-7

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