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

Abstract

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.

Cranioplasty for patients with disorders of consciousness

“…Firstly, patients diagnosed with DOC within 3 months may have a better natural prognosis, and secondly, early CP may provide benefits to consciousness recovery. Previous studies and systematic reviews have found that the benefits of improved nervous system function were greater with early (≤90 days) compared with late surgery (>90 days) (3,19), whereas the greatest improvement in cognitive function was noted when CP was performed within 3 to 6 months after DC (20). The reported incidence of complications in early and late CP remains controversial.…”

Super early cranial repair improves the prognosis of patients with craniocerebral injury

“…However, other studies have shown that super early CP can shorten the operation time, reduce intraoperative blood loss, and improve the neurological function and prognosis. 15 The above-mentioned meta-analysis by Malcolm et al., 16 which is the most recent to date, also demonstrated that super early (<90 days) CP significantly improved the prognosis of neurological function. Bender et al.…”

Bony Union and Flap Resorption in Cranioplasty with Autologous Subcutaneous Pocket Preserved Bone Flap: Early Report on an Ambidirectional CT Scan-Based Study

“…In their retrospective study, Bjornson et al compared early cranioplasty (33-90 days interval) with late cranioplasty (more than 90 days interval) and found no statistical difference between the two in complication rates. 37 In a retrospective study on 108 cases of cranioplasty by Ernst et al 31 in which subcutaneous bone flap storage was done, the mean time to cranioplasty was 104.31 days. However, they did not study the correlation between the bony union and the interval between the primary surgery and cranioplasty.…”