Early Cranioplasty Benefits Patients with Obvious Bilateral Frontotemporal Bone Window Collapse After Decompressive Craniectomy

Zhu, Haifeng; Ji, Chengfu; Zy, Shen; Luo, Zhengxiang; Shi, Lei

doi:10.1016/j.wneu.2018.02.080

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…A previous study on malignant middle cerebral artery infarction suggested that late CP after DC decreases the incidence of hydrocephalus (21). 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).…”

Section: Timing Of Surgerymentioning

confidence: 96%

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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Section: Timing Of Surgerymentioning

confidence: 96%

Cranioplasty for patients with disorders of consciousness

Dang¹,

Ping²,

Guo³

et al. 2021

Ann Palliat Med

View full text Add to dashboard Cite

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Complications in Staged Late Titanium Cranioplasty and Ventriculoperitoneal Shunting for Patients with Traumatic Brain Injury

Zheng

et al. 2019

World Neurosurgery

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Handmade Cranioplasty: An Obsolete Procedure or a Surgery That Is Still Useful?

Zoli

Gino

Cuoci

et al. 2020

Journal of Craniofacial Surgery

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Custom made cranioplasty (CM CPL) represents the gold standard for cranial defect reconstruction, allowing an adequate protection of the brain with good cosmetic results. Nevertheless, it is an expensive procedure, requiring time for preparation of the prothesis. Aim of this study is to evaluate whether and in what cases handmade cranioplasty (HM CPL) still represents a valid alternative to CM CPL. Therefore, all consecutive cranioplasties in our center from 2013 to 2019 have been analyzed. Size and location of cranial defect have been considered, as the cause of decompression. Morbidity rate and final outcome have been evaluated. Series includes 143 patients (61% males, mean age: 60 years, SD:16). HM CPL was performed in 59 cases (41.2%) and CM in the remaining 84 (58.8%). HM CPL was preferred for smaller cranial defects (p: 0.22), inferior to 100 cm2 (p: 0.01) located in fronto-parietal-occipital area (p: 0.01). Furthermore, HM CPL results in the first choice after removal of infiltrative tumors (p: 0.02). Surgical complications consisted in 14 (9%) infections, 8 hematomas (5.6%), and one cranioplasty displacement (0.7%). At follow-up, in 85.3% of cases the CPL is still in place with satisfactory cosmetic and functional outcome (86.5% of HM CPL, 84.5% of CM CPL). HM CPL may still represent an effective and economic alternative procedure, when specific patient selection criteria are respected. This technique requires a long learning learning curve and demanding surgical maneuvers. Our handmade reconstruction technique with some hints to improve the esthetic result is presented.

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Early Cranioplasty Benefits Patients with Obvious Bilateral Frontotemporal Bone Window Collapse After Decompressive Craniectomy

Cited by 3 publications

References 21 publications

Cranioplasty for patients with disorders of consciousness

Cranioplasty for patients with disorders of consciousness

Complications in Staged Late Titanium Cranioplasty and Ventriculoperitoneal Shunting for Patients with Traumatic Brain Injury

Handmade Cranioplasty: An Obsolete Procedure or a Surgery That Is Still Useful?

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