Early or late cranioplasty following decompressive craniotomy for traumatic brain injury: A systematic review and meta-analysis

Zheng, Feng; Xu, Hao; Spreckelsen, Niklas von; Stavrinou, Pantelis; Timmer, Marco; Goldbrunner, Roland; Cao, Fang; Ran, Qishan; Li, Gang; Fan, Ruiming; Zhang, Qiang; Chen, Wei; Yao, Shengtao; Krischek, Boris

doi:10.1177/0300060518755148

Cited by 30 publications

(21 citation statements)

References 41 publications

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“…While waiting for results of an ongoing randomized controlled trial (RCT) on early vs. late CP promoted by NIHR Global Health Research Group on Neurotrauma, the timing of reconstructive CP should rather be based on an objective case-by-case assessment of the neurological status of each patient, resolution of brain swelling, and complications associated with large calvarial defects rather than arbitrary time windows (73) and should be performed as soon as brain swelling resolves on CT scan, provided that the patient is not in an infectious state (89).…”

Section: Discussionmentioning

confidence: 99%

Cranioplasty Following Decompressive Craniectomy

et al. 2020

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Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic.

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Section: Discussionmentioning

confidence: 99%

Cranioplasty Following Decompressive Craniectomy

et al. 2020

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“…Incision complications may be frequent with early CP among patients with severe TBI having Glasgow Coma Scale scores of 3-8 points and bilateral frontotemporal bone window collapse after DC, whereas the long-term prognosis (according to the Glasgow Outcome Scale scores) may not differ between early and late CP (22). A meta-analysis found that early surgery can reduce the operation time and subdural effusion, and may be related to fewer scars (23). Delayed CP and the development of hydrocephalus are associated with poor prognosis in patients with severe TBI (17,24).…”

Section: Timing Of Surgerymentioning

confidence: 99%

Cranioplasty for patients with disorders of consciousness

Dang¹,

Ping²,

Guo³

et al. 2021

Ann Palliat Med

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Background: Cranioplasty (CP) is necessary for patients with disorders of consciousness (DOC) and skull defects. However, due to the complexity of these conditions, the surgical indications are conservative, and there are few published reports. This study aimed to assess the outcomes and complications of CP in patients with DOC, and to optimize the management of transcalvarial herniation (TCH) and hydrocephalus.Methods: A total of 87 patients with DOC who underwent CP at our center between December 2016 and April 2019 were selected. The patients were divided into traumatic brain injury (TBI) and non-TBI groups, and the complications, outcomes, and costs were compared. Factors associated with prognosis and surgical complications were identified using multivariate logistic regression analysis.Results: Postoperative complications occurred in 18 patients (20.7%). The complication rate was higher in the TBI group than in the non-TBI group (P=0.031). Preoperative ventriculoperitoneal shunt (VPS) was identified as a risk factor for incision complication (P=0.032), and non-traumatic cause tended to be a protective factor against postoperative hydrocephalus (P=0.055). One year after CP, 25 patients (28.7%) regained full consciousness [Extended Glasgow Outcome Scale (GOSE) ≥3] and 10 patients (11.5%) achieved partial self-care (GOSE =4). Multivariate analyses revealed that minimally conscious state (MCS) vs. vegetative state/unresponsive wakefulness syndrome (VS/UWS) (P=0.000) and early CP (P=0.023) were potential indicators for the recovery of consciousness.Conclusions: Our findings suggest that CP is safe in patients with DOC and may be beneficial for the recovery of consciousness. Early surgery and surgery for MCS provide better results. Timely CP in patients with TCH can help to reduce preoperative VPS, control incision complications, and detect and intervene in potential hydrocephalus.

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“…Our results add valuable information to solve the current equipoise regarding the management and timing of cranioplasty in the presence of a hydrocephalus requiring shunt treatment [ 10 , 14 , 15 ]. While there seems to be a consensus among most studies that a VPS is a major risk factor for complications in cranioplasty procedures including subdural or epidural fluid collections, intracerebral hemorrhage, infections, bone flap resorption, and seizures, the timing of these two procedures, i.e., as a one-stage or two-stage procedures, is less clear.…”

Section: Discussionmentioning

confidence: 99%

Cranioplasty following ventriculoperitoneal shunting: lessons learned

et al. 2020

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Objective Cranioplasty (CP) is considered as a straightforward and technically unchallenging operation; however, complication rates are high reaching up to 56%. Presence of a ventriculoperitoneal shunt (VPS) and timing of CP are reported risk factors for complications. Pressure gradients and scarring at the site of the cranial defect seem to be critical in this context. The authors present their experiences and lessons learned. Methods A consecutive series of all patients who underwent CP at the authors’ institution between 2002 and 2017 were included in this retrospective analysis. Complications were defined as all events that required reoperation. Logistic regression analysis and chi-squared test were conducted to evaluate the complication rates according to suspected risk factors. Results A total of 302 patients underwent cranioplasty between 2002 and 2017. The overall complication rate was 17.5%. Complications included epi-/subdural fluid collection (7.3%) including hemorrhage (4.6%) and hygroma (2.6%), bone graft resorption (5.3%), bone graft infection (2.0%), and hydrocephalus (5.7%). Overall, 57 patients (18.9%) had undergone shunt implantation prior to CP. The incidence of epi-/subdural fluid collection was 19.3% in patients with VPS and 4.5% in patients without VPS, OR 5.1 (95% CI 2.1–12.4). Incidence of hygroma was higher in patients who underwent early CP. Patients with temporary shunt ligation for CP did not suffer from complications. Conclusion CP in patients with a VPS remains a high-risk procedure. Any effort to understand the pressure dynamics and to reduce factors that may trigger the formation of a large epidural space must be undertaken.

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Early or late cranioplasty following decompressive craniotomy for traumatic brain injury: A systematic review and meta-analysis

Cited by 30 publications

References 41 publications

Cranioplasty Following Decompressive Craniectomy

Cranioplasty Following Decompressive Craniectomy

Cranioplasty for patients with disorders of consciousness

Cranioplasty following ventriculoperitoneal shunting: lessons learned

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