J Korean Neurosurg Soc.  2008 Oct;44(4):211-216. 10.3340/jkns.2008.44.4.211.

Comparative Study of Outcomes between Shunting after Cranioplasty and in Cranioplasty after Shunting in Large Concave Flaccid Cranial Defect with Hydrocephalus

• Oh CH
• Park CO
• Hyun DK
• Park HC
• Yoon SH

• KMID: 2189574
• DOI: http://doi.org/10.3340/jkns.2008.44.4.211

Abstract

OBJECTIVE
The cranioplasty and ventriculoperitoneal (VP) shunt operation have been used to treat a large cranial defect with posttraumatic hydrocephalus (PTH). The aim of this study was to evlauate the difference of outcomes between in the shunting after the cranioplasty (group 1) and the cranioplasty after the shunting (group 2) in a large flaccid cranial defect with PTH.
METHODS
In this study, a retrospective review was done on 23 patients undergoing the cranioplasty and VP shunt operation after the decompressive craniectomy for a refractory intracranial hypertension from 2002 to 2005. All of 23 cases had a large flaccid concave cranial defect and PTH. Ten cases belong to group 1 and 13 cases to group 2. The outcomes after operations were compared in two groups 6 months later.
RESULTS
The improvement of Glasgow outcome scale (GOS) was seen in 8 cases (80.0%) of total 10 cases in group 1, and 6 cases (46.2%) of 13 cases in group 2. Three (75.0%) of 4 cases with hemiparesis in group 1 and 3 of 6 cases (50.0%) in group 2 were improved. All cases (2 cases) with decrease of visual acuity were improved in each group. Dysphasia was improved in 3 of 5 cases (60%) in group 1 and 4 of 6 cases (66.6%) in group 2.
CONCLUSION
These results suggest that outcomes in group 1 may be better than in group 2 for a large flaccid concave cranial defect with PTH.

Keyword

Large flaccid concave cranial defect; Cranioplasty; Shunt

MeSH Terms

Aphasia
Decompressive Craniectomy
Glasgow Outcome Scale
Humans
Hydrocephalus
Intracranial Hypertension
Paresis
Retrospective Studies
Visual Acuity