Is There An Optimal Time for Performing Cranioplasties? Results from a Prospective Multinational Study

Quah, Boon Leong; Low, Hu Liang; Wilson, Mark; Bimpis, Alexios; Nga, Vincent Diong Weng; Lwin, Sein; Zainuddin, Noor Hazlina; Wahab, Nasser Abd; Salek, Al Amin

doi:10.1016/j.wneu.2016.06.081

Cited by 34 publications

(24 citation statements)

References 20 publications

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“…(Shamay‐Tsoory, Tomer, Goldsher, Berger, & Aharon‐Peretz, ) However, Malcom et al, in a more recent meta‐analysis, including three motor outcomes and a tool specific for postcoma patients, confirmed the positive effect of cranioplasty on neurological function and claimed that an early procedure may enhance this effect (Malcolm et al, ). Similarly, many recent studies recommend early cranioplasty because of its association with clinical improvement (Bender et al, ; Chibbaro et al, ; Liang et al, ; Quah et al, ), which can be performed as early as 2 weeks postcraniectomy (and in any case not later than 6 months) to lower the overall cost of care by eliminating the need for additional hospital admissions (Beauchamp et al, ). Indeed, it would seem that the majority of neurocognitive changes tend to be at their maximum initially and then decline gradually (Di Stefano et al, ), given that ipsilateral low cerebral blood flows increased and reached normal levels after CP (Erdogan et al, ), raising the recovery of motor and cognitive functioning (Su et al, ).…”

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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“…Studies usually report 3 months as the cutoff between early and late cranioplasty. 23,24 Many patients with large cranial defects after DC can safely undergo cranioplasty at an early stage. 25 Our data also suggest that patients who undergo late cranioplasty benefit from a lower complication rate.…”

Section: Intracranial Perfusion Pressure Changes: As Per Thementioning

confidence: 99%

Massive Brain Swelling after Cranioplasty: A Case Report

Zhang

Pan

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background Cranioplasty is a common procedure in neurosurgery. It is usually performed following decompressive craniectomy (DC). However, complications may occur after the operation, such as massive brain swelling. Up to now, far too little attention has been given to this severe complication. We report one case of fatal cerebral swelling after cranioplasty and analyze the possible mechanism of this complication. Case Description The patient was a 40-year-old man who had a severe right basal ganglia cerebral hemorrhage and underwent DC ∼ 2 months before. One day before scheduled cranioplasty, a lumbar cerebrospinal fluid drainage was placed. The cranioplasty itself was uneventful. However, he gradually fell into a coma, and his right pupil was moderately dilated 20 hours after the surgery. A brain computed tomography (CT) scan indicated massive right cerebral edema with compressed right midbrain. The patient did not regain consciousness, and he remained quadriplegic. Conclusion It is necessary to increase awareness of complications of cranioplasty in high-risk patients. The lessons learned from this case include avoiding excessive drainage of cerebrospinal fluid. Patients with low-density lesions in the brain need to be treated with caution. Once the CT scan shows massive cerebral swelling, the patient has a poor prognosis.

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“…Tasiou et al51) reported delayed cranioplasty preference is associated with efforts to decrease postoperative infection, especially for traumatic brain injuries. Recently, several reports recommend early cranioplasty, because it was found that cranioplasty improved clinical outcomes 364247). In the aspect of postoperative infection, multinational prospective designed study says no difference exists of the infection rates between early and delayed cranioplasty 42).…”

Section: Optimal Timing Of Cranioplastymentioning

confidence: 99%

“…Recently, several reports recommend early cranioplasty, because it was found that cranioplasty improved clinical outcomes 364247). In the aspect of postoperative infection, multinational prospective designed study says no difference exists of the infection rates between early and delayed cranioplasty 42). In meta-analysis, there was no difference in the chances of developing postoperative infection between early and late cranioplasty 37)…”

Section: Optimal Timing Of 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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Is There An Optimal Time for Performing Cranioplasties? Results from a Prospective Multinational Study

Cited by 34 publications

References 20 publications

Timing for cranioplasty to improve neurological outcome: A systematic review

Timing for cranioplasty to improve neurological outcome: A systematic review

Massive Brain Swelling after Cranioplasty: A Case Report

Review of Cranioplasty after Decompressive Craniectomy

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