Abstract
Objective: An increased interest in the surgical procedures of decompressive craniectomy (DC) and subsequent cranioplasty (CP) has emerged during the last decades with specific focus on mortality and complication rates. The aim of the present study was to evaluate long-term neurological and cosmetic outcomes as well as Quality of Life (QoL) after CP surgery.Methods: We retrospectively reviewed the medical records of CP patients treated at our institution between 2004 and 2014 and performed a follow-up examination, with evaluation of neurological outcome using the modified Rankin Scale (mRS) and the Glasgow outcome scale (GOS), QoL (SF-36 and EQ-5D-3L). Furthermore, the cosmetic results after CP were analyzed.Results: A total of 202 CP-patients were included in the present study. The main indications for DC and subsequent CP were space-occupying cerebral ischemia (32%), traumatic brain injury (TBI, 26%), intracerebral or subarachnoid hemorrhage (32%) and infection (10%). During a mean follow-up period of 91.9 months 46/42.6% of patients had a favorable neurological outcome (mRS ≤ 3/GOS ≥ 4). Patients with ischemia had a significant worse outcome (mRS 4.3 ± 1.5) compared with patients after TBI (3.1 ± 2.3) and infectious diseases requiring CP (2.4 ± 2.3). The QoL analysis showed that <1/3rd of patients (31.2%) had a good QoL (SF-36) with a mean EQ-5D-VAS of 59 ± 26. Statistical analysis confirmed a significant worse QoL of ischemia patients compared to other groups whereas multivariate regression analysis showed no other factors which may had an impact on the QoL. The majority (86.5%) of patients were satisfied with the cosmetic result after CP and regression analysis showed no significant factors associated with unfavorable outcomes.Conclusion: Long-term outcome and QoL after CP were significantly influenced by the medical condition requiring DC. Early detection and evaluation of QoL after CP may improve the patient's outcome due to an immediate initiation of targeted therapies (e.g., occupational- or physiotherapy).
Highlights
Cranioplasty (CP) after craniectomy (DC) is an essential surgical procedure in order to cover the originated skull defect, to protect the patient’s brain from outside forces and to re-integrate patients into “normal” life
69 patients died during the follow-up period, but were included in the neurological outcome analysis
Our results showed that patients with decompressive craniectomy (DC) and CP due to ischemia were more affected in their quality of life (QoL) (VAS 48.8 ± 21.8) than patients with other indications like traumatic brain injury (TBI) (VAS 67.6 ± 28.2)
Summary
Cranioplasty (CP) after (decompressive) craniectomy (DC) is an essential surgical procedure in order to cover the originated skull defect, to protect the patient’s brain from outside forces and to re-integrate patients into “normal” life. Several studies have analyzed potential risk factors for complications [4, 7,8,9,10,11,12,13,14]. Neurological rehabilitation and especially quality of life (QoL) in respective patients have gained increased attention. It has been well-established that the potential for neurological improvement after CP surgery is present especially during the first month after DC [16]. Patients with favorable outcome after DC and CP desire to return to normal life as quickly as possible Cosmetic stigmata such as conspicuous scaring or retraction/bulging of the scalp can have a significant impact on individuals. These abnormalities can lead to daily confrontation of patients with their disease and subsequent negative effects on their activities
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