Timing of cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke

Piedra, Mark P.; Ragel, Brian T.; Doğan, Aclan; Coppa, Nicholas D.; Delashaw, Johnny B.

doi:10.3171/2012.10.jns121037

Cited by 90 publications

(88 citation statements)

References 17 publications

(23 reference statements)

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“…There is no study however, that examines the effect of timing on the clinical outcome of patients. In accordance with the available literature, timing does not influence complications, but there might be an advantage for early reinsertion (<3 months), especially with respect to the risk for infections [51,52,53,54,55,56]. Recently published studies reported an approximate overall complication rate of up to 35% [51,52].…”

Section: Surgical Treatmentsupporting

confidence: 61%

Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review

Zweckberger¹,

Jüettler

Bösel

et al. 2014

Cerebrovasc Dis

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Background: Space-occupying malignant stroke of the middle cerebral artery (MCA) is associated with a high mortality rate of up to 80% under conservative treatment. Although there is convincing evidence that decompression craniectomy can significantly reduce mortality rate and improve neurological outcome in young patients (<60 years), many surgeons are still hesitant to recommend hemicraniectomy for stroke patients. Summary: This review addresses some major issues that appear to be an obstacle to decompression craniectomy, in particular, indicating surgery for patients >60 years or with infarcts of the dominant hemisphere. Furthermore, it emphasizes technical issues such as timing and size of the craniectomy, additional temporal lobectomy, and resection of the temporal muscle, as well as duraplasty and cranioplasty. According to the current literature, decompression craniectomy in older patients can increase survival without most severe disabilities, although, most survivors need assistance in most bodily needs. Involvement of the dominant hemisphere results in aphasia that might partly recover in younger patients, although, considering the neuropsychological deficits caused by infarctions of the nondominant hemisphere, involvement of the dominant hemisphere does not pose as a contraindication for decompression craniectomy. Furthermore, there is convincing evidence that surgery should be performed within 48 h after the onset of symptoms and the size of the craniectomy should be at least 12 cm as a minimum. An additional lobectomy or the resection of the temporal muscle, however, can only be part of individual treatment options. Conceding the weak evidence, it is recommended to close the dura by some form of a duraplasty avoiding cerebrospinal fluid leakages or scarring between the cortex and the scalp leading to injuries during reimplantation of the bone-flap. Complications associated with decompression surgery (hemorrhages, infections, ‘sinking skin-flap syndrome', cerebrospinal fluid leakages, hydrocephalus, seizures), with the infarction itself, or with those that occur during the ICU course (cardiac and pulmonary complications) appear acceptable and are mostly treatable, especially considering the fatal course of conservative treatment. Key Message: This review summarizes the current state of the literature about decompression craniectomy of patients with malignant stroke addressing, in particular, critical surgical issues, and thus, help surgeons to make decisions confidently for/or against performing surgery.

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Section: Surgical Treatmentsupporting

confidence: 61%

Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review

Zweckberger¹,

Jüettler

Bösel

et al. 2014

Cerebrovasc Dis

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“…[6][7][8][9][10][11][14][15][16]18,20,21,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Several studies 19,32,[43][44][45][46] have reported an incidence of the syndrome of 1-15% and a time latency of 3-6 months from the DC to the onset of the symptoms.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography

Paredes

Castaño

Cepeda

et al. 2016

Journal of Neurotrauma

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Cranioplasties are performed to protect the brain and correct cosmetic defects, but there is growing evidence that this procedure may result in neurological improvement. We prospectively studied cranioplasties performed at our hospital over a 5-year period. The National Institute of Health Stroke Scale and Barthel index were recorded prior to and within 72 h after the cranioplasty. A perfusion computed tomography (PCT) and transcranial Doppler sonography (TCDS) were performed prior to and 72 h after the surgery. For the PCT, regions irrigated by the anterior cerebral artery, the middle cerebral artery (MCA), the posterior cerebral artery, and the basal ganglia were selected, as well as the mean values for the hemisphere. The sonography was performed in the sitting and the supine position for the MCA and internal carotid. The velocities, pulsatility index, resistance index, and Lindegaard ratio (LR) were obtained, as well as a variation value for the LR (DLR = LR sitting -LR supine). Fifty-four patients were included in the study. Of these, 23 (42.6%) patients presented with objective improvement. The mean cerebral blood flow of the defective side (m-CBF-d) increased from 101.86 to 117.17 mL/100 g/min ( p = 0.064), and the m-CBF of the healthy side (m-CBF-h) increased from 128.14 to 145.73 mL/100 g/min ( p = 0.028). With regard to the TCDS, the DLR was greater on the defective side prior the surgery in those patients who showed improvement (1.295 vs. -0.714; p = 0.002). Cranioplasty resulted in clinical improvement in 40% of the patients, with an increase in the post-surgical CBF. The larger variations in the LR when the patient is moved from the sitting to the supine position might predict the clinical improvement.

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“…We found 253 potentially eligible articles of which 9 studies [5,6,8,9,27,28,32,34,41] were included. 244 non-pertinent titles or abstracts were excluded (Fig.…”

Section: Search Strategymentioning

confidence: 99%

Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: A systematic review

Niu

et al. 2015

Clinical Neurology and Neurosurgery

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Timing of cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke

Cited by 90 publications

References 17 publications

Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review

Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review

The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography

Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: A systematic review

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