Early Cranioplasty Improved Rehabilitation in Patients With Traumatic Skull Injuries

Cong, Zhongxiao; Shao, Xianhao; Zhang, Lei; Zhao, Duanyun; Zhou, Xudong; Yi, Chiling; Shao, Yi

doi:10.1097/wnq.0000000000000133

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…CT perfusion [ 107 ] and transcranial Doppler ultrasonography [ 92 ] have shown improvement in cerebral blood flow following cranioplasty. There are now multiple reports, some specifically from TBI patient cohorts [ 7 , 20 , 23 , 35 , 36 , 43 , 53 , 60 , 61 , 68 , 116 ], suggesting that cranioplasty aids neurological recovery. Skull contour restoration is of particular importance to patients cosmetically and may improve their psychosocial interactions and quality of life in general.…”

Section: Results (Including Discussion and Consensus Statements)mentioning

confidence: 99%

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

et al. 2019

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Background Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. Results The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

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Section: Results (Including Discussion and Consensus Statements)mentioning

confidence: 99%

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

et al. 2019

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“…Such timing is favored by some centers given reports of functional improvement after early cranioplasty. 1,7,11,21 Our data suggest that the ideal time for early cranioplasty, if desired, is probably between 14 and 30 days to balance the risk of infection with neurocognitive improvement since interrupting the wound healing process earlier than 14 days seems to predispose to subsequent wound complications.…”

Section: Discussionmentioning

confidence: 99%

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Morton¹,

Abecassis²,

Hanson³

et al. 2016

JNS

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Predictors of infection afterobJective The authors' aim was to report the largest study on predictors of infection after cranioplasty and to assess the predictive value of intraoperative bone flap cultures before cryopreservation. methods They retrospectively examined all cranioplasties performed between March 2004 and November 2014. Throughout this study period, the standard protocol during initial craniectomy was to obtain a culture swab of the extracted autologous bone flap (ABF)-prior to its placement in cytostorage-to screen for microbial contamination. Two consecutive protocols were employed for the use and interpretation of the intraoperative swab culture results: A) From March 2004 through June 2013, any culture-positive ABF (+ABF) was discarded and a custom synthetic prosthesis was implanted at the time of cranioplasty. B) From July 2013 through November 2014, any ABF with a skin flora organism was not discarded. Instead, cryopreservation was maintained and the +ABF was re-implanted after a 10-minute soak in bacitracin irrigation as well as a 3-minute soak in betadine. results Over the 10.75-year period, 754 cranioplasty procedures were performed. The median time from craniectomy to cranioplasty was 123 days. Median follow-up after cranioplasty was 237 days for protocol A and 225 days for protocol B. The overall infection rate after cranioplasty was 6.6% (50 cases) occurring at a median postoperative Day 31. Staphylococcus spp. were involved as the causative organisms in 60% of cases. Culture swabs taken at the time of initial craniectomy were available for 640 ABFs as 114 ABFs were not salvageable. One hundred twenty-six (20%) were culture positive. Eighty-nine +ABFs occurred during protocol A and were discarded in favor of a synthetic prosthesis at the time of cranioplasty, whereas 37 +ABFs occurred under protocol B and were reimplanted at the time of cranioplasty. Cranioplasty material did not affect the postcranioplasty infection rate. There was no significant difference in the infection rate among sterile ABFs (7%), +ABFs (8%), and synthetic prostheses (5.5%; p = 0.425). All 3 +ABF infections under protocol B were caused by organisms that differed from those in the original intraoperative bone culture from the initial craniectomy. A cranioplasty procedure ≤ 14 days after initial craniectomy was the only significant predictor of postcranioplasty infection (p = 0.007, HR 3.62). coNclusioNs Cranioplasty procedures should be performed at least 14 days after initial craniectomy to minimize infection risk. Obtaining intraoperative bone cultures at the time of craniectomy in the absence of clinical infection should be discontinued as the culture results were not a useful predictor of postcranioplasty infection and led to the unnecessary use of synthetic prostheses and increased health care costs.

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Cranioplasty: Does Timing Have Any Effect on the Degree of Neurological Recovery or the Complication Rate?

Mahmooth

Malcolm

Rindler

2019

Evidence for Neurosurgery

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Early Cranioplasty Improved Rehabilitation in Patients With Traumatic Skull Injuries

Cited by 4 publications

References 18 publications

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Cranioplasty: Does Timing Have Any Effect on the Degree of Neurological Recovery or the Complication Rate?

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