J Korean Neurotraumatol Soc.  2011 Oct;7(2):74-77. 10.13004/jknts.2011.7.2.74.

Safety and Efficacy of Early Cranioplasty after Decompressive Craniectomy in Traumatic Brain Injury Patients

• Cho KC
• Park SC
• Choe IS
• Seo DH

• KMID: 2019917
• DOI: http://doi.org/10.13004/jknts.2011.7.2.74

Abstract

OBJECTIVE
Patients with large cranial defects after decompressive craniectomy have suffered from complications, including sinking flap syndrome and syndrome of the trephined. A large cranial defect is one of the indications for cranioplasty, and recently, early cranioplasty has been advanced. To assess the safety and efficacy of early cranioplasty, we performed early cranioplasty.
METHODS
From January 2009 to December 2010, a total of 36 patients who underwent cranioplasty were enrolled in this study. Group I included 15 patients who underwent early cranioplasty within 6 weeks. Group II included 21 patients who underwent delayed cranioplasty 6 weeks after decompressive craniectomy. In all patients, brain computed tomographic (CT) scans were performed and laboratory results were checked for identification of infections. Duraplasty with artificial dura, use of polymethylmethacrylate (PMMA) for reconstruction, and fixation materials were checked in order to evaluate the effect on complication after the cranioplasty procedure. Outcomes of the procedure were evaluated 1 month after cranioplasty using the Barthel index of activity of daily living (ADL). To evaluate the safety of early cranioplasty, we compared the ratio of infection, subdural fluid collection, and ventricle dilatation in the early cranioplasty group (Group I) and the delayed cranioplasty group (Group II).
RESULTS
Mean periods between decompressive craniectomy and cranioplasty of Groups I and II were 35.20+/-3.76 (29-42) and 62.95+/-14.82 (44-102) days. Mean Barthel indexes of ADL about 1 month after cranioplasty in Groups I and II were 65.67+/-5.30 (55-75) and 47.86+/-10.67 (30-75). Differences between the two groups were statistically significant (p<0.05). None of the patients suffered surgery related complications during the follow-up period.
CONCLUSION
We suggest that with appropriate selection of patients, early cranioplasty for large cranial defects after decompressive craniectomy would be safe and helpful for improvement of neurologic function of patients with severe traumatic brain injury.

Keyword

Early cranioplasty; Decompressive craniectomy

MeSH Terms

Activities of Daily Living
Brain
Brain Injuries
Decompressive Craniectomy
Dilatation
Follow-Up Studies
Humans
Polymethyl Methacrylate
Polymethyl Methacrylate

Reference

1. Beauchamp KM, Kashuk J, Moore EE, Bolles G, Rabb C, Seinfeld J, et al. Cranioplasty after postinjury decompressive craniectomy: is timing of the essence? J Trauma. 2010; 69:270–274.

2. Carvi Y, Nievas MN, Höllerhage HG. Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders. Neurol Res. 2006; 28:139–144.

3. Cheng YK, Weng HH, Yang JT, Lee MH, Wang TC, Chang CN. Factors affecting graft infection after cranioplasty. J Clin Neurosci. 2008; 15:1115–1119.

4. Chun HJ, Yi HJ. Efficacy and safety of early cranioplasty, at least within 1 month. J Craniofac Surg. 2011; 22:203–207.

5. Dujovny M, Aviles A, Agner C, Fernandez P, Charbel FT. Cranioplasty: cosmetic or therapeutic? Surg Neurol. 1997; 47:238–241.

6. Fodstad H, Ekstedt J, Fridén H. CSF hydrodynamic studies before and after cranioplasty. Acta Neurochir Suppl (Wien). 1979; 28:514–518.

7. Isago T, Nozaki M, Kikuchi Y, Honda T, Nakazawa H. Sinking skin flap syndrome: a case of improved cerebral blood flow after cranioplasty. Ann Plast Surg. 2004; 53:288–292.

8. Liang W, Xiaofeng Y, Weiguo L, Gang S, Xuesheng Z, Fei C, et al. Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head trauma. J Craniofac Surg. 2007; 18:526–532.

9. Schiffer J, Gur R, Nisim U, Pollak L. Symptomatic patients after craniectomy. Surg Neurol. 1997; 47:231–237.

10. Segal DH, Oppenheim JS, Murovic JA. Neurological recovery after cranioplasty. Neurosurgery. 1994; 34:729–731. discussion 731.

11. Winkler PA, Stummer W, Linke R, Krishnan KG, Tatsch K. Influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism. J Neurosurg. 2000; 93:53–61.

12. Yadla S, Campbell PG, Chitale R, Maltenfort MG, Jabbour P, Sharan AD. Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review. Neurosurgery. 2011; 68:1124–1129. discussion 1130.

13. Yamaura A, Makino H. Neurological deficits in the presence of the sinking skin flap following decompressive craniectomy. Neurol Med Chir (Tokyo). 1977; 17:43–53.

14. Yang XJ, Hong GL, Su SB, Yang SY. Complications induced by decompressive craniectomies after traumatic brain injury. Chin J Traumatol. 2003; 6:99–103.

15. Zhang GL, Yang WZ, Jiang YW, Zeng T. Extensive duraplasty with autologous graft in decompressive craniectomy and subsequent early cranioplasty for severe head trauma. Chin J Traumatol. 2010; 13:259–264.