Complications following cranioplasty and relationship to timing: A systematic review and meta-analysis

Malcolm, James G.; Rindler, Rima S.; Chu, Jason; Grossberg, Jonathan A; Pradilla, Gustavo

doi:10.1016/j.jocn.2016.04.017

Cited by 154 publications

(134 citation statements)

References 67 publications

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“…Several studies define "early cranioplasty" as a cranioplasty performed within 91 days from decompressive craniectomy (Malcolm et al, 2018(Malcolm et al, , 2016Xu et al, 2015). Notably, Xu et al (2015) sustain that early cranioplasty may reduce the duration of surgery by reducing difficulties in dissecting the scalp flap and fitting the bone flap.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Timing for cranioplasty to improve neurological outcome: A systematic review

et al. 2018

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“…Previous studies found that an early cranioplasty was better than one later on to improve the prognosis of patients with large cranial defects after DC (Chibbaro et al, 2011;Liang et al, 2007;Nalbach, Ropper, Dunn, & Gormley, 2012). However, the optimal timing of cranioplasty after DC has not been established yet (Malcolm et al, 2016;Morton et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Postoperative complications influencing the long‐term outcome of head‐injured patients after decompressive craniectomy

Zhang

Liu

et al. 2018

Brain and Behavior

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ObjectivePostoperative complications are common in patients who underwent decompressive craniectomy (DC) after traumatic brain injury (TBI). However, little is known about the degree of association between the postoperative complications and the long‐term outcome of adult TBI patients after DC. The aim of this study was to evaluate the risk of postoperative complications that influenced the long‐term outcome of DC in TBI patients.MethodA total of 121 patients were studied up to 6 months after DC in TBI. The collected data included demographic, clinical and radiological information, postoperative complications, and Glasgow Outcome Scale‐Extended (GOSE) scores at follow‐up 6 months after DC. Based on their GOSE scores, they were divided into two functional groups: favorable (GOSE = 5–8) or unfavorable outcome (GOSE = 2–4) group. The characteristics of the two groups were compared using statistical analysis. Finally, a regression model was established and a receiver operating characteristic (ROC) curve was applied to analyze its performance power.ResultsOf 121 admitted patients, 31 (25.62%) sustained an unfavorable outcome. A logistic regression analysis showed that the presence of Glasgow Coma Scale (GCS) scores on admission (odds ratio [OR] 0.285, p = 0.001), posttraumatic hydrocephalus (PTH) (OR 8.688, p = 0.003), craniectomy site (OR 8.068, p = 0.033), and postoperative progressive hemorrhagic injury (PHI) (OR 6.196, p = 0.026) were independent risk factors that correlated with an unfavorable outcome. Analysis using ROC curves demonstrated that these factors had different accuracies in predicting an unfavorable outcome (AUC = 0.852 for GCS scores on admission; AUC = 0.826 for PTH, AUC = 0.617 for craniectomy site; AUC = 0.616 for postoperative PHI). The performance power of the GCS scores on admission and PTH influenced the patient's outcomes to a similar degree (p = 0.623), and either predicted the outcome better than the craniectomy site or the postoperative PHI (p < 0.05, respectively).ConclusionThese findings suggest that the occurrence of PTH and postoperative PHI were independently associated with an unfavorable long‐term outcome after DC in patients with TBI. Early prevention and treatment of PTH and postoperative PHI may be beneficial to improve the long‐term outcome, especially in patients with lower admission GCS scores or bilateral DC.

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“…One author reported 390.4 days as the mean time between craniectomy and cranioplasty in 2015 39). Some authors have defined “early cranioplasty” as cranioplasty less than 91 days after craniectomy 3756). In Korea, if the patient's condition is favorable, the timing of cranioplasty can be shortened to less than six weeks following DC 1453).…”

Section: Optimal Timing Of Cranioplastymentioning

confidence: 99%

“…There is a report using computed tomography house field unit scores for resorption diagnosis. Children and large skull flaps, long cryopreservation periods, fragmented flaps and Glasgow Outcome Scale at the time of cranioplasty were reported as risk factors 103337)…”

Section: Complications After Cranioplastymentioning

confidence: 99%

Review of Cranioplasty after Decompressive Craniectomy

Cho

Kang

2017

Korean J Neurotrauma

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Cranioplasty is an in evitable operation conducted after decompressive craniectomy (DC). The primary goals of cranioplasty after DC are to protect the brain, achieve a natural appearance and prevent sinking skin flap syndrome (or syndrome of the trephined). Furthermore, restoring patients' functional outcome and supplementing external defects helps patients improve their self-esteem. Although early cranioplasty is preferred in recent year, optimal timing for cranioplasty remains a controversial topic. Autologous bone flaps are the most ideal substitute for cranioplasty. Complications associated with cranioplasty are also variable, however, post-surgical infection is most common. Many new materials and techniques for cranioplasty are introduced. Cost-benefit analysis of these new materials and techniques can result in different outcomes from different healthcare systems.

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Complications following cranioplasty and relationship to timing: A systematic review and meta-analysis

Cited by 154 publications

References 67 publications

Timing for cranioplasty to improve neurological outcome: A systematic review

Timing for cranioplasty to improve neurological outcome: A systematic review

Postoperative complications influencing the long‐term outcome of head‐injured patients after decompressive craniectomy

Review of Cranioplasty after Decompressive Craniectomy

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