Timing of Cranioplasty after Decompressive Craniectomy for TraumaKeywords: cranioplasty, traumatic brain injury, craniectomy, outcome, surgeryInteractive Manuscript
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What is the background behind your study?
The appropriate timing of cranioplasty after decompressive craniectomy for trauma is not known.
What is the purpose of your study?
Case series suggest early cranioplasty is associated with higher rates of infection while delaying cranioplasty may be associated with higher rates of bone resorption.
Describe your patient group.
Between 2001 and 2010 we identified 157 patients that underwent cranioplasty after decompressive craniectomy for trauma. There were 33 early and 124 late cranioplasty patients.
Describe what you did.
Patients were separated into early (within 6 weeks of craniectomy) and late cohorts. We compared rates of infection, hydrocephalus, epidural hematoma, and bone resorption between the two cohorts.
Describe your main findings.
There was no significant difference in age, sex, comorbidities, operative time, or hospital stay between the cohorts. Complication rates between the early and late cohorts showed no significant difference (30.3% early; 36.2% late, p=0.6056). There were no significant differences in the rates of infection (15.1% early; 9.7% late, p=0.3957). The late cohort had higher rates of epidural hematoma (0% early; 2.4% late, p=0.3716) and more than double the rate of bone resorption (9.1% early; 19.4% late, p=0.2064) although not statistically significant. In the subset of patients who underwent cranioplasty in the same hospitalization as craniectomy (n=20) the overall complication rate was lower (30%) and the rate of infection was lower (5.0%) than the late group but not statistically significant.
Describe the main limitation of this study.
This is a retrospective study.
Describe your main conclusion.
The timing of cranioplasty after craniectomy for trauma does not affect rates of infection, hydrocephalus, epidural hematoma, or bone resorption.
Describe the importance of your findings and how they can be used by others.
If clinically feasible, cranioplasty during the same hospitalization as craniectomy can be performed without increasing the risk of complications.
The appropriate timing of cranioplasty after decompressive craniectomy for trauma is not known.
Case series suggest early cranioplasty is associated with higher rates of infection while delaying cranioplasty may be associated with higher rates of bone resorption.
Between 2001 and 2010 we identified 157 patients that underwent cranioplasty after decompressive craniectomy for trauma. There were 33 early and 124 late cranioplasty patients.
Patients were separated into early (within 6 weeks of craniectomy) and late cohorts. We compared rates of infection, hydrocephalus, epidural hematoma, and bone resorption between the two cohorts.
There was no significant difference in age, sex, comorbidities, operative time, or hospital stay between the cohorts. Complication rates between the early and late cohorts showed no significant difference (30.3% early; 36.2% late, p=0.6056). There were no significant differences in the rates of infection (15.1% early; 9.7% late, p=0.3957). The late cohort had higher rates of epidural hematoma (0% early; 2.4% late, p=0.3716) and more than double the rate of bone resorption (9.1% early; 19.4% late, p=0.2064) although not statistically significant. In the subset of patients who underwent cranioplasty in the same hospitalization as craniectomy (n=20) the overall complication rate was lower (30%) and the rate of infection was lower (5.0%) than the late group but not statistically significant.
This is a retrospective study.
The timing of cranioplasty after craniectomy for trauma does not affect rates of infection, hydrocephalus, epidural hematoma, or bone resorption.
If clinically feasible, cranioplasty during the same hospitalization as craniectomy can be performed without increasing the risk of complications.
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