Complications associated with early cranioplasty for patients with traumatic brain injury: a 25-year single-center analysis

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  • 1 Department of Neurological Surgery,
  • | 2 School of Medicine,
  • | 3 Department of Biostatistics,
  • | 4 Harborview Injury Prevention Research Center, and
  • | 5 School of Global Health, University of Washington, Seattle, Washington
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OBJECTIVE

Cranioplasty is a technically simple procedure, although one with potentially high rates of complications. The ideal timing of cranioplasty should minimize the risk of complications, but research investigating cranioplasty timing and risk of complications has generated diverse findings. Previous studies have included mixed populations of patients undergoing cranioplasty following decompression for traumatic, vascular, and other cerebral insults, making results challenging to interpret. The objective of the current study was to examine rates of complications associated with cranioplasty, specifically for patients with traumatic brain injury (TBI) receiving this procedure at the authors’ high-volume level 1 trauma center over a 25-year time period.

METHODS

A single-institution retrospective review was conducted of patients undergoing cranioplasty after decompression for trauma. Patients were identified and clinical and demographic variables obtained from 2 neurotrauma databases. Patients were categorized into 3 groups based on timing of cranioplasty: early (≤ 90 days after craniectomy), intermediate (91–180 days after craniectomy), and late (> 180 days after craniectomy). In addition, a subgroup analysis of complications in patients with TBI associated with ultra-early cranioplasty (< 42 days, or 6 weeks, after craniectomy) was performed.

RESULTS

Of 435 patients identified, 141 patients underwent early cranioplasty, 187 patients received intermediate cranioplasty, and 107 patients underwent late cranioplasty. A total of 54 patients underwent ultra-early cranioplasty. Among the total cohort, the mean rate of postoperative hydrocephalus was 2.8%, the rate of seizure was 4.6%, the rate of postoperative hematoma was 3.4%, and the rate of infection was 6.0%. The total complication rate for the entire population was 16.8%. There was no significant difference in complications between any of the 3 groups. No significant differences in postoperative complications were found comparing the ultra-early cranioplasty group with all other patients combined.

CONCLUSIONS

In this cohort of patients with TBI, early cranioplasty, including ultra-early procedures, was not associated with higher rates of complications. Early cranioplasty may confer benefits such as shorter or fewer hospitalizations, decreased financial burden, and overall improved recovery, and should be considered based on patient-specific factors.

ABBREVIATIONS

TBI = traumatic brain injury.

Schematics of transseptal interforniceal resection of a superiorly recessed colloid cyst. ©Mark Souweidane, published with permission. See the article by Tosi et al. (pp 813–819).

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  • 1

    Alkhaibary A, Alharbi A, Alnefaie N, Oqalaa Almubarak A, Aloraidi A, Khairy S. Cranioplasty: a comprehensive review of the history, materials, surgical aspects, and complications. World Neurosurg. 2020;139:445452.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Cho YJ, Kang SH. Review of cranioplasty after decompressive craniectomy. Korean J Neurotrauma. 2017;13(1):914.

  • 3

    Bjornson A, Tajsic T, Kolias AG, et al. A case series of early and late cranioplasty-comparison of surgical outcomes. Acta Neurochir (Wien). 2019;161(3):467472.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Chaturvedi J, Botta R, Prabhuraj AR, Shukla D, Bhat DI, Devi BI. Complications of cranioplasty after decompressive craniectomy for traumatic brain injury. Br J Neurosurg. 2016;30(2):264268.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Goedemans T, Verbaan D, van der Veer O, et al. Complications in cranioplasty after decompressive craniectomy: timing of the intervention. J Neurol. 2020;267(5):13121320.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Kim JH, Hwang SY, Kwon TH, Chong K, Yoon WK, Kim JH. Defining "early" cranioplasty to achieve lower complication rates of bone flap failure: resorption and infection. Acta Neurochir (Wien). 2019;161(1):2531.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Malcolm JG, Rindler RS, Chu JK, Grossberg JA, Pradilla G, Ahmad FU. Complications following cranioplasty and relationship to timing: a systematic review and meta-analysis. J Clin Neurosci. 2016;33:3951.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Morton RP, Abecassis IJ, Hanson JF, et al. Timing of cranioplasty: a 10.75-year single-center analysis of 754 patients. J Neurosurg. 2018;128(6):16481652.

  • 9

    Piedra MP, Nemecek AN, Ragel BT. Timing of cranioplasty after decompressive craniectomy for trauma. Surg Neurol Int. 2014;5:25.

  • 10

    Schuss P, Vatter H, Marquardt G, et al. Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J Neurotrauma. 2012;29(6):10901095.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Tora MS, Malcolm JG, Mahmooth Z, et al. Complication rates in early versus late cranioplasty—a 14-year single-center case series. Oper Neurosurg (Hagerstown). 2021;20(4):389396.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Bender A, Heulin S, Röhrer S, et al. Early cranioplasty may improve outcome in neurological patients with decompressive craniectomy. Brain Inj. 2013;27(9):10731079.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Kim BW, Kim TU, Hyun JK. Effects of early cranioplasty on the restoration of cognitive and functional impairments. Ann Rehabil Med. 2017;41(3):354361.

  • 14

    Liang W, Xiaofeng Y, Weiguo L, et al. Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head trauma. J Craniofac Surg. 2007;18(3):526532.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Sharma R, Janjani L, Kulkarni V, Patrikar S, Singh S. therapeutic efficacy of cranioplasty after decompressive craniectomy for traumatic brain injury: a retrospective study. J Oral Maxillofac Surg. 2018;76(11):2423.e12423.e7.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Songara A, Gupta R, Jain N, Rege S, Masand R. Early cranioplasty in patients with posttraumatic decompressive craniectomy and its correlation with changes in cerebral perfusion parameters and neurocognitive outcome. World Neurosurg. 2016;94:303308.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Archavlis E, Carvi Y Nievas M. The impact of timing of cranioplasty in patients with large cranial defects after decompressive hemicraniectomy. Acta Neurochir (Wien). 2012;154(6):10551062.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Borger V, Schuss P, Kinfe TM, Vatter H, Güresir E. Decompressive craniectomy for stroke: early cranioplasty is a predictor for postoperative complications. World Neurosurg. 2016;92:8388.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Oh JS, Lee KS, Shim JJ, Yoon SM, Doh JW, Bae HG. Which one is better to reduce the infection rate, early or late cranioplasty?. J Korean Neurosurg Soc. 2016;59(5):492497.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Iaccarino C, Kolias A, Adelson PD, et al. Consensus statement from the international consensus meeting on post-traumatic cranioplasty. Acta Neurochir (Wien). 2021;163(2):423440.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Xu H, Niu C, Fu X, et al. Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: a systematic review. Clin Neurol Neurosurg. 2015;136:3340.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Thavarajah D, De Lacy P, Hussien A, Sugar A. The minimum time for cranioplasty insertion from craniectomy is six months to reduce risk of infection—a case series of 82 patients. Br J Neurosurg. 2012;26(1):7880.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Cheng YK, Weng HH, Yang JT, Lee MH, Wang TC, Chang CN. Factors affecting graft infection after cranioplasty. J Clin Neurosci. 2008;15(10):11151119.

  • 24

    Quah BL, Low HL, Wilson MH, et al. Is there an optimal time for performing cranioplasties? Results from a prospective multinational study. World Neurosurg. 2016;94:1317.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Beauchamp KM, Kashuk J, Moore EE, et al. Cranioplasty after postinjury decompressive craniectomy: is timing of the essence?. J Trauma. 2010;69(2):270274.

  • 26

    Nasi D, Dobran M. Can early cranioplasty reduce the incidence of hydrocephalus after decompressive craniectomy? A meta-analysis. Surg Neurol Int. 2020;11:94.

  • 27

    Ashayeri K, M Jackson E, Huang J, Brem H, Gordon CR. Syndrome of the trephined: a systematic review. Neurosurgery. 2016;79(4):525534.

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