Primary cranioplasty for calvarial compound depressed fractures; 2 centers experience

Abstract

IntroductionTraumatic brain injuries (TBIs) are among the leading causes of death and disability in younger age groups. Current guidelines to prevent infection in compound depressed fractures of the skull recommend fragment removal and debridement, and the cranial defect usually is left for a secondary cranioplasty. However, recent studies demonstrated no difference in infection rates between primary and secondary reconstruction. Herein we point out our preliminary experience using a single-staged approach to surgical management of open depressed skull fractures.MethodsThis study included 72 patients between Egypt and Saudi Arabia with compound depressed fractures of the skull that underwent primary cranioplasty either by elevation or by titanium reconstruction within the first 72 h post-traumatic brain injuries. We report surgery-specific characteristics and overall complications over a 12-month follow-up period.ResultsFifty-nine (82%) immediate primary cranioplasty patients were without complications. Twelve complications were seen in twelve patients. Infection accounted for only 2.8%, while the rest consisted of convulsions (6.9%), CSF rhinorrhea (4.2%), CSF leak, seroma, and re-operation (1.4%) each. One patient died after 20 postoperative days due to pulmonary embolism.ConclusionNeurosurgical expertise and readily available medical facilities within the civilian populations have significantly changed the traditional approach in calvarial CDF patients within the first 72 h post-trauma, where primary cranioplasty has proven to be a valid procedure with minimal morbidities compared to the traditional two-stage protocol.