485 Cranial Stair-Step Technique Versus Standard Wound Closures: Minimizing Postoperative Complications in Neuro-Oncologic Surgery

INTRODUCTION: Craniotomies for tumor resection can at times result in wound complications which can be devastating in the treatment of neuro-oncological patients. A cranial stair-step technique was recently introduced as an approach to mitigate these complications, especially in this patient population who often exhibit additional risk factors including steroids, chemoradiation, and VEGF inhibitor treatments. METHODS: A retrospective chart review was conducted on patients with intracranial neoplasms undergoing primary craniotomy at a single institution. Patients with prior craniotomies and less than three months of follow-up were excluded. Analyses were performed using JMP Pro. RESULTS: Of 1833 records reviewed, 415 patients were included in the analysis, 140 of whom underwent the stair-step technique while the rest underwent traditional craniotomy closures. The stair-step cohort was older, exhibited a lower baseline creatinine, and had a higher prevalence of coronary artery disease. Though stair-step patients were administered fewer steroids before (40.71% vs. 54.91%, p = 0.01) and after surgery (87.14% vs. 93.82%, p = 0.02), they received more radiation preoperatively (15.00% vs. 8.00%, p= 0.03). They also underwent fewer operations for recurrences and residuals (1.43% vs. 12.4%, p < 0.01). The average follow-up duration for all patients was 19.4 months (±17.42). Postoperatively, the stair-step group had a shorter hospital stay (6.43 ± 5.75 vs. 8.16 ± 7.26 days, p = 0.01), lower incidence of pseudomeningocele (0% vs. 2.55%, p = 0.02), and fewer wound complications (1.43% vs. 7.64%, p = 0.01) including no soft tissue infection (0% vs. 5.09%, p = 0.01). Furthermore, the need for reoperation due to wound complications (0.71% vs. 6.90%, p < 0.01) was significantly lower in the stair-step group. CONCLUSIONS: The cranial stair-step technique is safe and effective in reducing rates of wound complications and reoperation for neuro-oncologic patients requiring craniotomy.