Simultaneous Cranioplasty vs. Staged Cranioplasty for Reconstruction of Bilateral Craniectomy

Abstract

Objective: Cranioplasty (CP) following decompressive craniectomy (DC) is of low complexity surgically. However, even this “simple” procedure may have a high complication rate, especially for the reconstruction of bilateral craniectomy compared to the reconstruction of unilateral craniectomy. This study aimed to assess and compare the rate of complications between simultaneous and staged CP for the reconstruction of bilateral craniectomy. Methods: All patients who underwent CP at our institution following DC for stroke or traumatic brain injury between 2008 and 2017 were reviewed. A total of 139 patients were identified, of whom 17 underwent bilateral CP. Simultaneous and staged CP was performed in 6 and 11 patients, respectively. The median time from craniectomy until CP was 94 days (range, 25-220 days). In patients with staged CP, the interval between the first CP and the second CP was 15 days (range, 6-43 days). The overall rate of complications, such as postoperative bleeding, seizures, postoperative infection, and hydrocephalus, was 16%. Results: There were no statistically significant differences in outcome variables between simultaneous CP and staged CP for the reconstruction of bilateral craniectomy, except for estimated blood loss. The estimated blood loss was lower in patients who underwent staged CP than in those who underwent simultaneous CP. The length of hospital stay was naturally longer when staged CP was performed.Conclusion: No significant differences were found in outcome variables between simultaneous and staged CP for the reconstruction of bilateral craniectomy, except for estimated blood loss and the length of hospital stay. Therefore, simultaneous CP might be more beneficial for economic reasons than staged CP.