Timing for cranioplasty to improve neurological outcome: A systematic review

Cola, Maria Cristina De; Corallo, Francesco; Pria, Deborah; Buono, Viviana Lo; Calabrò, Rocco Salvatore

doi:10.1002/brb3.1106

Cited by 53 publications

(37 citation statements)

References 57 publications

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“…Firstly, patients diagnosed with DOC within 3 months may have a better natural prognosis, and secondly, early CP may provide benefits to consciousness recovery. Previous studies and systematic reviews have found that the benefits of improved nervous system function were greater with early (≤90 days) compared with late surgery (>90 days) (3,19), whereas the greatest improvement in cognitive function was noted when CP was performed within 3 to 6 months after DC (20). The reported incidence of complications in early and late CP remains controversial.…”

Section: Timing Of Surgerymentioning

confidence: 99%

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: 99%

Cranioplasty for patients with disorders of consciousness

Dang¹,

Ping²,

Guo³

et al. 2021

Ann Palliat Med

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show abstract

“…Within this controversy, the systematic review developed by De Cola et al indicated that an interval of 3 to 6 months between DC and CP is favorable to better motor and cognitive recoveries. 24 Regarding the surgical technique, CP, by itself, is already presented as a therapeutic approach, and is even considered sufficient, in the circumstances in which the brain is flaccid. [25][26][27] There are even reports in the literature of patients in whom the mechanism of deviation of CSF proved to be unnecessary.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Cranioplasty and External Ventricular Drain Implantation in Patients with Hydrocephalus: Case Series and Literature Review

Macêdo

Netto

Franke

et al. 2021

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Introduction The increase in intracranial pressure (ICP) is a neurological complication resulting from numerous pathologies that affect the brain and its compartments. Therefore, decompressive craniectomy (DC) is an alternative adopted to reduce ICP in emergencies, especially in cases refractory to clinical therapies, in favor of patient survival. However, DC is associated with several complications, including hydrocephalus (HC). The present study presents the results of an unusual intervention to this complication: the implantation of an external ventricular drain (EVD) in the intraoperative period of cranioplasty (CP). Methods Patients of both genders who presented with HC and externalization of the brain through the cranial vault after decompressive hemicraniectomy and underwent EVD implantation, to allow the CP procedure, in the same surgical procedure, were included. Results Five patients underwent DC due to a refractory increase in ICP, due to automobile accidents, firearm projectiles, falls from stairs, and ischemic strokes. All evolved with HC. There was no uniform time interval between DC and CP. The cerebrospinal fluid (CSF) was drained according to the need for correction of cerebral herniation in each patient, before undergoing cranioplasty. All patients progressed well, without neurological deficits in the immediate postoperative period. Conclusion There are still several uncertainties about the management of HC resulting from DC. In this context, other CP strategies simultaneous to the drainage of CSF, not necessarily related to ventriculoperitoneal shunt (VPS), should be considered and evaluated more deeply, in view of the verification of efficacy in procedures of this scope, such as the EVD addressed in this study.

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“…The restoration of the anatomic barrier between intracranial structures and the environment normalize the dynamics of CSF and the blood flow inside the brain. 1,4,5 Even though the ideal moment for performing cranioplasty remains uncertain, recent studies show that it should be done between 3 to 6 months later, in order to allow for significant motor skill and cognitive recovery. 4,12 Cranioplasty after DC for management of elevated intracranial pressure is a neurosurgical procedure that seeks to restore stasis, improve the dynamic of CSF and establish the conditions for protecting the brain.…”

Section: Discussionmentioning

confidence: 99%

“…Decompressive craniectomy (DC) is efficient in reducing intracranial pressure (ICP) in patients with intracranial hypertension in complications of brain infarction that do not respond to clinical treatment, traumatic brain injury (TBI), intracerebral hemorrhage and aneurysmal intracerebral hemorrhage. 1,4 Hydrocephalus is present in 2 to 29% of those who undergo craniectomy, possibly requiring ventriculoperitoneal shunt (VPS) after the subacute stage. Most of the patients needing craniectomy accompanied by VPS develop sinking skin flap syndrome.…”

Section: Introductionmentioning

confidence: 99%

Ventriculoperitoneal shunt occlusion and cranioplasty

Macêdo¹,

Netto²,

Maricevich³

et al. 2020

roneuro

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Decompressive craniectomy (DC) is an urgent neurosurgical procedure, effective in the reduction of intracranial pressure (ICP) in patients with elevated ICP and in complications of brain infarction that do not respond to clinical treatment; traumatic brain injury (TBI); intracerebral haemorrhage (ICH) and aneurysmal intracerebral haemorrhage. Symptomatic hydrocephalus is present in 2 to 29% of patients who undergo craniectomy. They may require a ventriculoperitoneal shunt (VPS). The literature does not yet show standard management of cranioplasty in patients who have previously undergone a shunt, showing evidence of sinking skin flap syndrome. This case shows parenchymal expansion after VPS occlusion and cranioplasty in the patient’s profile. The 23-year-old male patient, right-handed, went to the hospital in January 2017 due to severe traumatic brain injury following multiple traumas. The patient underwent urgent DC surgery for the management of elevated ICP. The patient developed hydrocephalus. hydrocephalus. It was decided to perform the VPS implant. After 2 years, and with quite a sunken flap, the patient was submitted to cranioplasty procedure after shunt occlusion was performed. The patient left the hospital receiving outpatient care with no more complaints. In spite of the favourable outcome, new studies are fundamental to decide upon the best approach.

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Timing for cranioplasty to improve neurological outcome: A systematic review

Cited by 53 publications

References 57 publications

Cranioplasty for patients with disorders of consciousness

Cranioplasty for patients with disorders of consciousness

Simultaneous Cranioplasty and External Ventricular Drain Implantation in Patients with Hydrocephalus: Case Series and Literature Review

Ventriculoperitoneal shunt occlusion and cranioplasty

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