Article
Early vs. late cranioplasty after TBI – a single-centre analysis of 129 cases with regard to perioperative modalities as well as postoperative complications and neurological results
Frühe vs. späte Kranioplastik nach SHT – eine Single-Center-Analyse von 129 Fällen hinsichtlich perioperativer Modalitäten, postoperativer Komplikationen und neurologischen Ergebnissen
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Authors
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Dustin Hädrich
- Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Thomas Westermaier
- Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Andrea Cattaneo
- Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Almuth Friederike Keßler
- Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Ralf-Ingo Ernestus
- Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Paul Pakos
- Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Nadine Lilla
- Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland; Universitätsklinikum Magdeburg, Neurochirurgische Klinik, Magdeburg, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Cranioplasty (CP) after decompressive craniectomy (DC) is an elective procedure that serves to reconstruct and restore the cranial vault from a functional and aesthetic perspective. Although it is a routine procedure, the optimal timing of CP remains an object of discussion. The traditional time of delayed CP (3-6 months after DC) is more and more questioned by neurosurgeons, while trying to find advantages for early CP (1-3 months after DC). We conducted this study to compare both timings in TBI patients with regard to perioperative modalities, postoperative complications and neurological results.
Methods: This retrospective single-center study was conducted on 129 cases undergoing cranioplasty following TBI. Early cranioplasty patients (73/129) and late cranioplasty patients (56/129) were observed from 01/2005-12/2018. All patients were followed based on medical, operative and digital records. Postoperative complications were divided into short-term (< 30 days) and long-term (> 30 days). Neurological results (GOS, GOSE) were collected via telephone interview.
Results: Patients with early CP had a shorter surgery time, lower intraoperative blood loss and shorter postoperative hospitalization compared to late CP. The total re-operation rate was 10.2%, with late CP patients having to be revised in 17.9% of cases, while early CP patients were re-operated in 4.2% of cases. This represents a significant difference (p = 0.016) in favor of early CP. Moreover, late CP patients developed a significantly higher rate of postoperative epidural hematoma (p = 0.010). Even considering the minor complications, late CP patients showed a higher rate than early CP patients. In contrast, detailed examination of the minor complications revealed that early CP patients had a higher number of CSF pads. Furthermore, VP-Shunt-dependent postoperative hydrocephalus rates were significant higher in the early CP group (p = 0.036). The neurological outcome in GOS and GOSE were almost identical in the early and late CP group and represented a moderate disability.
Conclusion: The study showed that early CP patients had superior intra- and postoperative results compared to late CP patients. However, especially postoperative hydrocephalus CSF pad rates were higher at early CP patients, which differed from the results of other studies. This shows the need for further research to confirm the results of the present study and to contribute to the discussion for optimal timing of CP.
