Cranioplasty Following Decompressive Craniectomy.

Corrado Iaccarino,Angelos G Kolias,Louis-Georges Roumy,Amos Olufemi Adeleye,Kostas Fountas

doi:10.3389/fneur.2019.01357

Abstract

Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic.

Highlights

INTRODUCTIONThe operative surgery of therapeutic decompressive craniectomy (DC) for traumatic brain injury (TBI) involves the elevation of a free cranial convexital bone flap that is stored either in vivo (e.g., abdominal or thigh subcutaneous pouches) or in ex vivo mediums (deep freezing and tissue banking) [1, 2]
The operative surgery of therapeutic decompressive craniectomy (DC) for traumatic brain injury (TBI) involves the elevation of a free cranial convexital bone flap that is stored either in vivo or in ex vivo mediums [1, 2]
Regarded as a routine neurosurgical procedure, CP can be associated with significant morbidity [4, 5]

Summary

INTRODUCTION

The operative surgery of therapeutic decompressive craniectomy (DC) for traumatic brain injury (TBI) involves the elevation of a free cranial convexital bone flap that is stored either in vivo (e.g., abdominal or thigh subcutaneous pouches) or in ex vivo mediums (deep freezing and tissue banking) [1, 2]. Bony regeneration rates were reported in two patients having undergone CP at 6 months and 2.5 years, respectively [52] It is an appropriate material for use in large and complex cranial defect reconstruction [53]. The suggestion is that a lower biofilm formation, lower rate of colonization compared to titanium [53], targeted antimicrobial therapy, and a satisfactory area of revascularization allow optimal antibiotic delivery on-site and were all decisive in the possibility of avoiding prosthesis removal Shape is another important factor for a successful CP as an increased congruence between the patient and the implant will lead to a better outcome overall as well as improved aesthetic benefit.

Study design

Findings

CONCLUSION