Cranioplasty

Piazza, Matthew; Grady, M. Sean

doi:10.1016/j.nec.2016.11.008

Cited by 95 publications

(71 citation statements)

References 44 publications

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“…Cranial reconstruction (cranioplasty) following DC restores the original skull contour. Large skull defects following trauma DC leave the brain unprotected and hinder ICP regulation, CSF dynamics and cerebral blood flow, potentially giving rise to complications such as hydrocephalus and the syndrome of the trephined [ 54 , 69 ].…”

Section: Results (Including Discussion and Consensus Statements)mentioning

confidence: 99%

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

et al. 2019

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Background Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. Results The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

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Section: Results (Including Discussion and Consensus Statements)mentioning

confidence: 99%

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

et al. 2019

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“…CP was performed during the initial hospitalization for DC or in an elective setting, when there were no signs of persistent brain swelling [19]. In elective patients, CP was usually performed in the weeks/months following the first follow-up visit to the neurosurgical outpatient clinic (scheduled eight weeks after discharge from the hospital, while the patient was in a rehabilitation center/nursing home).…”

Section: Cranioplastymentioning

confidence: 99%

Complications in cranioplasty after decompressive craniectomy: timing of the intervention

et al. 2020

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Objective To prevent complications following decompressive craniectomy (DC), such as sinking skin flap syndrome, studies suggested early cranioplasty (CP). However, several groups reported higher complication rates in early CP. We studied the clinical characteristics associated with complications in patients undergoing CP, with special emphasis on timing. Methods A single-center observational cohort study was performed, including all patients undergoing CP from 2006 to 2018, to identify predictors of complications. Results 145 patients underwent CP: complications occurred in 33 (23%): 18 (12%) epi/subdural hemorrhage, 10 (7%) bone flap infection, 4 (3%) hygroma requiring drainage, and 1 (1%) post-CP hydrocephalus. On univariate analysis, acute subdural hematoma as etiology of DC, symptomatic cerebrospinal fluid (CSF) flow disturbance (hydrocephalus) prior to CP, and CP within three months after DC were associated with higher complication rates. On multivariate analysis, only acute subdural hematoma as etiology of DC (OR 7.5; 95% CI 1.9-29.5) and symptomatic CSF flow disturbance prior to CP (OR 2.9; 95% CI 1.1-7.9) were associated with higher complication rates. CP performed within three months after DC was not (OR 1.4; 95% CI 0.5-3.9). Pre-CP symptomatic CSF flow disturbance was the only variable associated with the occurrence of epi/ subdural hemorrhage. (OR 3.8; 95% CI 1.6-9.0) Conclusion Cranioplasty has high complication rates, 23% in our cohort. Contrary to recent systematic reviews, early CP was associated with more complications (41%), explained by the higher incidence of pre-CP CSF flow disturbance and acute subdural hematoma as etiology of DC. CP in such patients should therefore be performed with highest caution.

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“…The aim of a cranioplasty is to restore cosmetic appearances, protect the underlying brain from further injury and facilitate neurological recovery and rehabilitation [ 21 ]. A number of mechanisms have been proposed for reversible neurological disability following craniectomy—this includes cerebrospinal fluid flow disruption, venous sinus congestion, abnormal atmospheric pressures which can lead to ‘syndrome of the trephined’ and alterations in cellular metabolism [ 4 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…There is a considerable variation in practice in terms of timing of cranioplasty following DC [ 7 , 21 , 25 ]. Traditionally, a cranioplasty would be delayed to allow for cerebral oedema to resolve and for the patient's neurological status to improve, and to reduce the chance of wound infection and delayed hydrocephalus [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

A case series of early and late cranioplasty—comparison of surgical outcomes

et al. 2019

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Background Cranioplasty is an increasingly common procedure performed in neurosurgical centres following a decompressive craniectomy (DC), however, timing of the procedure varies greatly. Objectives The aim of this study is to compare the surgical outcomes of an early compared to a late cranioplasty procedure. Methods Ninety adult patients who underwent a prosthetic cranioplasty between 2014 and 2017 were studied retrospectively. Timing of operation, perioperative complications and length of stay were assessed. Early and late cranioplasties were defined as less or more than 3 months since craniectomy respectively. Results Of the 90 patients, 73% received a late cranioplasty and 27% received an early cranioplasty. The median interval between craniectomy and cranioplasty was 13 months [range 3–84] in late group versus 54 days [range 33–90] in early group. Twenty-two patients in the early group (91%) received a cranioplasty during the original admission while undergoing rehabilitation. Complications were seen in 25 patients (28%). These included wound or cranioplasty infection, hydrocephalus, symptomatic pneumocephalus, post-operative haematoma and cosmetic issues. The complication rate was 21% in the early group and 30% in the late group ( P value 0.46). There was no significant difference in the rate of infection or hydrocephalus between the two groups. Length of stay was not significantly increased in patients who received an early cranioplasty during their initial admission (median length of stay 77 days versus 63 days, P value 0.28). Conclusion We have demonstrated the potential for early cranioplasty to be a safe and viable option, when compared to delayed cranioplasty.

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Cranioplasty

Cited by 95 publications

References 44 publications

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

Complications in cranioplasty after decompressive craniectomy: timing of the intervention

A case series of early and late cranioplasty—comparison of surgical outcomes

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