Affiliation:
1. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA;
2. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA;
3. Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
Abstract
BACKGROUND:
Although not a technically difficult operation, cranioplasty is associated with high rates of complications. The optimal timing of cranioplasty to mitigate complications remains the subject of debate.
OBJECTIVE:
To report outcomes between patients undergoing cranioplasty at ultra-early (0-6 weeks), intermediate (6 weeks to 6 months), and late (>6 months) time frames. We report a novel craniectomy contour classification (CCC) as a radiographic parameter to assess readiness for cranioplasty.
METHODS:
A single-institution retrospective analysis of patients undergoing cranioplasty was performed. Patients were stratified into ultra-early (within 6 weeks of index craniectomy), intermediate (6 weeks to 6 months), and late (>6 months) cranioplasty cohorts. We have devised CCC scores, A, B, and C, based on radiographic criteria, where A represents those with a sunken brain/flap, B with a normal parenchymal contour, and C with “full” parenchyma.
RESULTS:
A total of 119 patients were included. There was no significant difference in postcranioplasty complications, including return to operating room (P = .212), seizures (P = .556), infection (P = .140), need for shunting (P = .204), and deep venous thrombosis (P = .066), between the cohorts. Univariate logistic regression revealed that ultra-early cranioplasty was significantly associated with higher rate of functional independence at >6 months (odds ratio 4.32, 95% CI 1.39-15.13, P = .015) although this did not persist when adjusting for patient selection features (odds ratio 2.90, 95% CI 0.53-19.03, P = .234).
CONCLUSION:
In appropriately selected patients, ultra-early cranioplasty is not associated with increased rate of postoperative complications and is a viable option. The CCC may help guide decision-making on timing of cranioplasty.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Neurology (clinical),Surgery