Effect of cranioplasty timing on the functional neurological outcome and postoperative complications

Abstract

Background: The optimal timing for performing cranioplasty and its effect on functional outcome remains debatable. Multiple confounding factors may come into role; including the material used, surgical technique, cognitive assessment tools, and the overall complications. The aim of this study is to assess the neurological outcome and postoperative complications in patients who underwent early versus late cranioplasty. Methods: A retrospective cohort study was conducted to investigate the neurological outcome and postoperative complications in patients who underwent cranioplasty between 2005 and 2018 at a Level l trauma center. Early and late cranioplasties were defined as surgeries performed within and more than 90 days of decompressive craniectomy, respectively. The Glasgow Outcome Score (GOS) and modified Rankin scale (mRS), recorded within 1 week of cranioplasty, were used to assess the neurological outcome. Results: A total of 101 cases of cranioplasty were included in the study. The mean age of the patients was 31.4 ± 13.9 years. Most patients (n = 86; 85.1%) were male. The mean GOS for all patients was 4.0 ± 1.0. The mean mRS was 2.2 ± 1.78. Hydrocephalus was noted in 18 patients (early, n = 6; late, n = 12; P = 0.48). Seizures developed in 28 patients (early, n = 12; late, n = 16; P = 0.77). Conclusion: The neurological outcome in patients who underwent early versus late cranioplasty is almost identical. The differences in the rates of overall postoperative complications between early versus late cranioplasty were statistically insignificant. The optimal timing for performing cranioplasty is mainly dependent on the resolution of cerebral swelling.

Comprehensive access strategies to the frontal sinus

“…Persistent infection and failures of the reconstruction in extensive procedures represent the main concerns. In this regard, an extended peri-operative antibiotic regimen, lasting up to 6--12 weeks [40 ▪ ,43] is generally advised, although the optimal timing and material for cranioplasty in case of anterior frontal table deformity is still a matter of debate [44 ▪ ,45].…”

Early Cranioplasty after Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury

“…34,35 Similarly, Aloraidi et al reported in their study insignificant differences in the rates of complications after early and late cranioplasty. 37 Hydrocephalus had been reported post cranioplasty in several studies and occurs due to disturbances in the CSF dynamics. 30,35 In our study the risk of occurrence of postoperative hydrocephalus requiring CSF diversion procedure did not differ significantly between early and late groups.…”

Considerations for Choice of Cranioplasty Material for Pediatric Patients

“…Appropriate timing of cranioplasty after craniectomy is also a highly debated subject. While many reports indicate there is no significant difference in cognitive outcomes between cranioplasties performed within 3 months of craniectomy and after, other complications such as hydrocephalus and wound breakdown contribute to outcomes data and may be more significantly impacted by timing [16-18]. Though our data indicate that shorter time to cranioplasty is a predictive factor for the complications studied, this result is confounded by the inclusion of implants placed on day zero of surgery, such as cranioplasty placed after removal of a skull tumor, many of which consisted of repair of secondary skull defects after previous cranioplasty or craniofacial surgery.…”