Complications of cranioplasty in relationship to traumatic brain injury: a systematic review and meta-analysis (original) (raw)
Related papers
2011
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.
Early Cranioplasty after Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury
Pan Arab Journal of Neurosurgery
BACKGROUND: Cranioplasty is performed after decompressive craniectomy (DC) mainly for protection of the brain and cosmetic purposes. Furthermore, cranioplasty may also improve neuronal and cognitive functions. Despite cranioplasty after DC is a common procedure, the proper timing for cranioplasty is still debatable. OBJECTIVE: This study aims at evaluating the impact of timing of cranioplasty after DC on functional and surgical outcomes in patients with severe traumatic brain injury. METHODS: This retrospective study included patients who underwent cranioplasty after DC for severe traumatic brain injury. Patients were divided into two groups based on the time to cranioplasty, either within 2 months (early group) or after 2 months from the initial DC (late group). Patients' demographics, clinical and radiological data, operative details, postoperative complications, and neurological status at the final visit were collected. Glasgow coma scale (GCS) was used to evaluate the initial neurological status; initial radiological findings at time of trauma were classified according to Marshall Classification Score of traumatic brain injury. Disability rating scale (DRS) and Glasgow outcome score (GOS) were used to evaluate the functional outcome. RESULTS: Sixty-two patients were included in this study ,44 males and 18 females, and the mean age was (33.2±15.1). Thirty six patients (58.1%) were included in the late group, while 26 patients (41.9%) were in the early group. There was no statistically significant difference in patients' characteristics, operative details or mean follow up time between the two groups. The mean GOS was higher in the early group but was not statistically significant (3.85 ±0.35 versus 3.56 ±0.30; p = 0.12), also there was no statistically significant difference in the DRS between early and late groups (8.85 ±2.05 versus 9.5 ±1.93; p = 0.33). Regarding complications of cranioplasty, there was insignificant difference between the two groups. CONCLUSION: Early cranioplasty can be done safely without higher rates of complications, and it may carry better neurological and functional outcomes than late cranioplasty, however this was not statistically significant.
Complications of cranioplasty after decompressive craniectomy for traumatic brain injury
Introduction. Decompressive craniectomy (DC)-a potentially life-saving intervention following traumatic brain injury (TBI) with medically refractory brain swelling-once performed, surviving patients, more often than not, undergo a second procedure with cranioplasty (CP) in the future. This study analyzes complications following CP after DC, as the beneficial effects of the DC can't be extrapolated in long run over a population unless one adds into it the complications associated with the CP in the survivors of TBI. Materials and methods. An observational study was performed retrospectively, with the review of case records. Demographic, clinical, and outcome data were collected, and complications were studied for any predictive parameters. A multivariate analysis was performed to identify factors that influenced these complications. Results. Data were collected for a total of 74 patients who underwent CP with a median age of 32, and a mean follow-up time of 2 years and 8 months. The mortality rate was 1.35% and overall complication rate 31%. The most significant factor determining complications were operating time more than 90 min Odds ratio (OR) 4.77 (1.61-14.20); timing of CP less than 3 months after craniectomy, OR 2.86 (1.48-8.11); age more than 20 years, OR 2.59 (1.20-6.53); and female gender, OR 1.91 (1.13-4.17). Conclusions. Although considered as a straight-forward procedure, the risks associated with this elective procedure should be kept in mind by the surgeon so that the patients and families can be apprised judiciously. It should be ascertained that patient and/or family consents for the procedure after being appropriately informed about the benefits and risks associated with the procedure.
Frontiers in Neurology, 2018
Background: In patients with severe traumatic brain injury (sTBI) treated with decompressive craniectomy (DC), factors affecting the success of later cranioplasty are poorly known. Objective: We sought to investigate if injury-and treatment-related factors, and state of recovery could predict the risk of major complications in cranioplasty requiring implant removal, and how these complications affect the outcome. Methods: A retrospective cohort of 40 patients with DC following sTBI and subsequent cranioplasty was studied. Non-injury-related factors were compared with a reference population of 115 patients with DC due to other conditions.
Asian Journal of Neurosurgery, 2019
The objective is to evaluate the efficacy of early decompressive craniectomy (DC) versus standard medical management ± late DC in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case–control studies, and prospective cohort studies on DC in moderate and severe TBI. Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS) and extended GCOS, and mortality. Data were extracted to Review Manager software. A total of 45 articles and abstracts that met the inclusion criteria were retrieved and analyzed. Ultimately, seven studies were included in our meta-analysis, which revealed that patients who had early DC had no statistically significant likelihood of having a favorable outcome at 6 months than those who had a standard medical care alone or with late DC (OR of favorable clinical outcome at 6 month...
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.8\_Aug2019/Abstract\_IJRR0045.html, 2019
Background: Decompressive craniectomy is most effective when used in conjunction with duraplasty. Decompressive craniectomy already has been proposed as a last ditch procedure in cases of uncontrollable raised intracranial pressure of various origins. Methods: This was a prospective observational study of patients with traumatic brain injury who underwent Decompressive craniectomy over a period of 18 months. A total of 96 patients were included in the study. Patients were followed up over a period of 3 months to identify the complications and outcome after decompressive craniectomy. The data was analysed using SSPE software (Chicago, Illinois, USA). P value of 0.05 was considered as statistically significant. Results: Final outcome was compared with various variables and there was no significant correlation when compared with age, sex, mode of injury, side and type of procedure (p-value>0.05). On comparision of final outcome with preoperative GCS, postoperative GCS, and postoperative neurological status there was significant correlation (p-value<0.05). Incidences of complications were compared with various variables but no significant correlation found. Conclusion: The survival rate of 83.9% was promising and 48.4% had favourable outcome. We conclude that those patients who had poor pre and postoperative GCS, they had more incidence of unfavourable outcome.
Acta Neurochirurgica
Background Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low-and middle-income countries. Results The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.
Trauma, 2020
Objectives Decompressive craniectomy is a last-tier therapy in the treatment of raised intracranial pressure after traumatic brain injury. We report the association of demographic, radiographic, and injury characteristics with outcome parameters in early (<24 h) and late (≥24 h) decompressive craniectomy following traumatic brain injury. Methods We retrospectively identified 204 patients (158 (early decompressive craniectomy) and 46 (late decompressive craniectomy)), with a median age of 34 years (range 2–78 years) between 2015 and 2018. The primary endpoint was Glasgow Outcome Scale Extended (GOSE) at 60 days, while secondary endpoints included Glasgow Coma Score (GCS) at discharge, mortality at 30 days, and length of hospital stay. Regression analysis was used to assess the independent predictive variables of functional outcome. Results With a clinical follow-up of 60 days, the good functional outcome (GOSE = 5–8) was 73.5% versus 74.1% (p = 0.75) in early and late decompressiv...
Journal of Evidence Based Medicine and Healthcare
The aim of the study was to investigate the therapeutics effects, complications and factors associated with prognosis of patients with severe Traumatic Brain Injury (TBI) in whom decompressive craniectomy (DC) was performed. METHODS A retrospective study was conducted between 2015 and 2019 and included patients with severe TBI who underwent decompressive craniectomy. The parameters assessed were clinical state using the Glasgow Coma Score (GCS), CT Scan findings, details of DC, complications, factors associated with mortality and neurological outcome upon discharge from hospital using Glasgow Outcome Scale (GOS). RESULTS A total of 83 patients were included in the study. The mean age of the patients was 32 ± 14 years. There were 68 (81.9%) males and 15 (18.1%) females. Most common cause for injury was road traffic accident (62%). The average Glasgow coma score at admission was 7 ± 3.44 (53%). Complications included contralateral hematoma (4.8%), external cerebral herniation (28.9%), seizures (6.0%), hydrocephalus (8.4%), postoperative infection (30.1%) etc. CONCLUSIONS Decompressive craniectomy is an important procedure to save the life of patients with severe TBI. However some complications associated with the procedure have to be kept in mind before using it in a generalised manner. Low GCS at admission, development of hydrocephalus and old age were factors associated with poor outcome.