Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications

Schuss, Patrick; Vatter, Hartmut; Marquardt, Gerhard; Imöhl, Lioba; Ulrich, Christian T; Seifert, Volker; Güresir, Erdem (2012). Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. Journal of neurotrauma, 29(6), pp. 1090-5. New York, N.Y.: M.A. Liebert 10.1089/neu.2011.2176

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Decompressive craniectomy (DC) due to intractably elevated intracranial pressure mandates later cranioplasty (CP). However, the optimal timing of CP remains controversial. We therefore analyzed our prospectively conducted database concerning the timing of CP and associated post-operative complications. From October 1999 to August 2011, 280 cranioplasty procedures were performed at the authors' institution. Patients were stratified into two groups according to the time from DC to cranioplasty (early, ≤2 months, and late, >2 months). Patient characteristics, timing of CP, and CP-related complications were analyzed. Overall CP was performed early in 19% and late in 81%. The overall complication rate was 16.4%. Complications after CP included epidural or subdural hematoma (6%), wound healing disturbance (5.7%), abscess (1.4%), hygroma (1.1%), cerebrospinal fluid fistula (1.1%), and other (1.1%). Patients who underwent early CP suffered significantly more often from complications compared to patients who underwent late CP (25.9% versus 14.2%; p=0.04). Patients with ventriculoperitoneal (VP) shunt had a significantly higher rate of complications after CP compared to patients without VP shunt (p=0.007). On multivariate analysis, early CP, the presence of a VP shunt, and intracerebral hemorrhage as underlying pathology for DC, were significant predictors of post-operative complications after CP. We provide detailed data on surgical timing and complications for cranioplasty after DC. The present data suggest that patients who undergo late CP might benefit from a lower complication rate. This might influence future surgical decision making regarding optimal timing of cranioplasty.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
UniBE Contributor:	Ulrich, Christian Thomas (B)
ISSN:	0897-7151
Publisher:	M.A. Liebert
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:37
Last Modified:	29 Mar 2023 23:32
Publisher DOI:	10.1089/neu.2011.2176
PubMed ID:	22201297
Web of Science ID:	000302949100008
URI:	https://boris.unibe.ch/id/eprint/14830 (FactScience: 221964)