Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy: Staged Surgery Is Associated with Fewer Postoperative Complications

Abstract

Decompressive craniectomy (DC) requires later cranioplasty (CP) in survivors. However, if additional ventriculoperitoneal shunt (VPS) placement due to shunt-dependent hydrocephalus is necessary, the optimal timing of both procedures still remains controversial. We therefore analyzed our computerized database concerning the optimal timing of CP and VPS regarding postoperative complications. From 2009-2014, 41 cranioplasty procedures with simultaneous or staged VPS placement were performed at the authors' institution. Patients were stratified into two groups according to the time from CP to VPS ("simultaneous" and "staged"). Patient characteristics, timing of CP and VPS, as well as procedure-related complications, were assessed and analyzed. Overall CP and VPS were performed simultaneously in 41% and in staged fashion in 59% of the patients. The overall complication rate was 27%. Patients who underwent simultaneous CP and VPS suffered significantly more often from complications compared with patients who underwent staged CP and VPS procedures (47% vs. 12%; P = 0.03). Patients with simultaneous CP and VPS had a significantly higher rate of infectious postoperative complications compared with patients with staged procedures (P = 0.003). On multivariate analysis, simultaneous CP and VPS procedure was the only significant predictor of postoperative complication after CP and VPS (P = 0.03). We provide detailed data on surgical timing and complications for cranioplasty and ventriculoperitoneal shunt placement after DC. The present data suggest that patients who undergo staged CP and VPS procedures might benefit from a lower complication rate. This might influence future surgical decision making regarding optimal timing of CP and VPS placement.