Early cranioplasty may improve outcome in neurological patients with decompressive craniectomy

Bender, Andreas; Heulin, Sandrine; Röhrer, Stefan; Mehrkens, Jan-Hinnerk; Heidecke, Volkmar; Straube, Andreas; Pfefferkorn, Thomas

doi:10.3109/02699052.2013.794972

Cited by 112 publications

(85 citation statements)

References 30 publications

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“…The Glasgow Coma Scale, preoperative Barthel Index, and the Coma Remission Scale may predict the risk of cranioplasty complications. 5,46 Even though the risk of infection with autologous graft can get relatively high (up to 33%), 12,33,34,52 many studies, including ours, suggest no difference in the infection rate between synthetic and autologous grafts. 9,47 limitations and strengths of the study…”

Section: Postcranioplasty Seizuresmentioning

confidence: 72%

“…We balanced the wait for maximal neurological improvement with early intervention to prevent hemodynamic changes in the CSF and cerebral blood flow that may occur if the flap was left out for a prolonged period of time. 5 Still, the large majority of our patients have undergone early cranioplasty (within 3 months). We found no significant association of age, sex, DM, and mechanism of injury (SAH, trauma, ischemic stroke) with postcranioplasty infection, which is consistent with the published literature.…”

Section: Timing Infection and Hydrocephalusmentioning

confidence: 97%

“…4,11 Some studies have shown that patients who had early cranioplasties had better functional outcomes, 3,5,46 whereas several others have shown that early cranioplasty (3-6 months) is associated with higher complication rates and worse outcomes, 3,4,[8][9][10]26,35,42 including hydrocephalus, increased intracranial pressure, and infection. Other studies have shown that late cranioplasty is associated with a higher risk of complications.…”

Section: Timing Infection and Hydrocephalusmentioning

confidence: 99%

“…17,38,42,48 Finally, recent studies, including a meta-analysis, have shown no difference in complication rates between early and late cranioplasties. 5,24,39,51 We did not account for the timing of cranioplasty in our study because our patients underwent early operation unless there was a convincing need to delay it, such as the presence of wound dehiscence, hydrocephalus, or evidence of persistent brain swelling. We balanced the wait for maximal neurological improvement with early intervention to prevent hemodynamic changes in the CSF and cerebral blood flow that may occur if the flap was left out for a prolonged period of time.…”

Section: Timing Infection and Hydrocephalusmentioning

confidence: 99%

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Complications following cranioplasty: incidence and predictors in 348 cases

Zanaty

Chalouhi

Starke

et al. 2015

JNS

200

165

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C ranioplasty is more than a cosmetic repair of cranial defects; it is part of the rehabilitation process following a patient's neurological injury. Recent studies have shown that cranioplasty may improve the patient's psychological status, social performance, and neurocognitive functioning. 1,14,19,21 The factors that contribute to periprocedural complications, including patients' demographic information, comorbidities, surgical procedure, and under lying disease, need to be thoroughly evaluated. Previous studies that were intended to answer these questions were limited by their design or by their sample size. Our aim was to evaluate risk factors that predispose patients to an increased risk of cranioplasty complications. Recent evidence in the literature emphasizes patient-specific factors over surgery-specific factors as major predictors of cranioplasty complications. 47,51 It is also becoming evident that surgical treatment for cranioplasty complications is associated with additional surgical procedures. 17,46 In this study, we evaluated the association between patient-specific factors and complications folabbreviatioNs AED = antiepileptic drug; DHC = decompressive hemicraniectomy; DM = diabetes mellitus; SAH = subarachnoid hemorrhage; TBI = traumatic brain injury. obJect The factors that contribute to periprocedural complications following cranioplasty, including patient-specific and surgery-specific factors, need to be thoroughly assessed. The aim of this study was to evaluate risk factors that predispose patients to an increased risk of cranioplasty complications and death. methods The authors conducted a retrospective review of all patients at their institution who underwent cranioplasty following craniectomy for stroke, subarachnoid hemorrhage, epidural hematoma, subdural hematoma, and trauma between January 2000 and December 2011. The following predictors were tested: age, sex, race, diabetic status, hypertensive status, tobacco use, reason for craniectomy, urgency status of the craniectomy, graft material, and location of cranioplasty. The cranioplasty complications included reoperation for hematoma, hydrocephalus postcranioplasty, postcranioplasty seizures, and cranioplasty graft infection. A multivariate logistic regression analysis was performed. Confidence intervals were calculated as the 95% CI. results Three hundred forty-eight patients were included in the study. The overall complication rate was 31.32% (109 of 348). The mortality rate was 3.16%. Predictors of overall complications in multivariate analysis were hypertension (OR 1.92, CI 1.22-3.02), increasing age (OR 1.02, CI 1.00-1.04), and hemorrhagic stroke (OR 3.84,). Predictors of mortality in multivariate analysis were diabetes mellitus (OR 7.56, CI 1.56-36.58), seizures (OR 7.25, CI 1.238-42.79), bifrontal cranioplasty (OR 5.40,, and repeated surgery for hematoma evacuation (OR 13.00, CI 1.51-112.02). Multivariate analysis was also applied to identify the variables that affect the development of seizures, the need for reoperation for hem...

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Section: Postcranioplasty Seizuresmentioning

confidence: 72%

Section: Timing Infection and Hydrocephalusmentioning

confidence: 97%

Section: Timing Infection and Hydrocephalusmentioning

confidence: 99%

Section: Timing Infection and Hydrocephalusmentioning

confidence: 99%

See 2 more Smart Citations

Complications following cranioplasty: incidence and predictors in 348 cases

Zanaty

Chalouhi

Starke

et al. 2015

JNS

200

165

View full text Add to dashboard Cite

show abstract

“…Severe craniocerebral injury, cerebral edema, and acute cerebral hernia often had to be underwent during the decompression craniectomy operation [7,8], and along with which, the second-stage cranioplasty will be faced. Although the cranioplasty belongs to the basic level operation, there are still some complications, such as cerebrospinal fluid leakage, infection, hemorrhage, dropsy, epilepsy, and others [1,9,10]; key comprehensive points of the second-stage cranioplasty is "artificial meningeal" stripping and forming; if the striping is smooth, it will contribute to short operation time, less bleeding, meningeal integrity, the suitable thickness flap, and small stretch to the brain tissue, which is followed by reduced postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Suturing-Free Artificial Dura with Dacron Heart Patch in Decompressive Craniectomy and Cranioplasty

et al. 2014

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Dacron heart patch has been used in decompressive craniectomy, performing the function of septa, mainly to prevent extra adhesion of temporal muscle and decompressive meningeal adhesion in the second-stage cranioplasty, so as to make the operation easier. Then, we made the following modification technology: (1) We used artificial suturing-free dura participate directly in the duraplasty. (2) Dacron patch is not in need of trimming the side holes and can directly cover the decompression window. From March 2012 to October 2013, we applied the technology of artificial dura with Dacron heart patch in 23 patients; after operation, we found that the initial depressive craniectomy cost less time, due to the tension-reduced suture which was not needed, and in the second-stage cranioplasty, the temporal was easy to remove and had no adhesion with the Dacron patch, so as to reach temporal muscle anatomy preservation, and with no obvious postoperative complication.

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Timing for cranioplasty to improve neurological outcome: A systematic review

et al. 2018

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IntroductionCranioplasty is a surgical technique applied for the reconstruction of the skullcap removed during decompressive craniectomy (DC). Cranioplasty improves rehabilitation from a motor and cognitive perspective. However, it may increase the possibility of postoperative complications, such as seizures and infections. Timing of cranioplasty is therefore crucial even though literature is controversial. In this study, we compared motor and cognitive effects of early cranioplasty after DC and assess the optimal timing to perform it.MethodsA literature research was conducted in PubMed, Web of Science, and Cochrane Library databases. We selected studies including at least one of the following test: Mini‐Mental State Examination, Rey Auditory Verbal Learning Test immediate and 30‐min delayed recall, Digit Span Test, Glasgow Coma Scale, Glasgow Outcome Scale, Coma Recovery Scale‐Revised, Level of Cognitive Functioning Scale, Functional Independence Measure, and Barthel Index.ResultsSix articles and two systematic reviews were included in the present study. Analysis of changes in pre‐ and postcranioplasty scores showed that an early procedure (within 90 days from decompressive craniectomy) is more effective in improving motor functions (standardized mean difference [SMD] = 0.51 [0.05; 0.97], p‐value = 0.03), whereas an early procedure did not significantly improve neither MMSE score (SMD = 0.06 [−0.49; 0.61], p‐value = 0.83) nor memory functions (SMD = −0.63 [−0.97; −0.28], p‐value < 0.001). No statistical significance emerged when we compared studies according to the timing from DC.ConclusionsIt is believed that cranioplasty performed from 3 to 6 months after DC may significantly improve both motor and cognitive recovery.

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Early cranioplasty may improve outcome in neurological patients with decompressive craniectomy

Abstract: Patients with decompressive craniectomy for management of intracranial hypertension may benefit from early cranioplasty.

Cited by 112 publications

References 30 publications

Complications following cranioplasty: incidence and predictors in 348 cases

Complications following cranioplasty: incidence and predictors in 348 cases

Suturing-Free Artificial Dura with Dacron Heart Patch in Decompressive Craniectomy and Cranioplasty

Timing for cranioplasty to improve neurological outcome: A systematic review

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