Abstract
BackgroundSecondary cranioplasty (CP) is considered to support the neurological recovery of patients after decompressive craniectomy (DC), but the treatment success might be limited by complications associated to confounders, which are not yet fully characterized. The aim of this study was to identify the most relevant factors based on the necessity to perform revision surgeries.MethodsData from 156 patients who received secondary CP following DC for severe traumatic brain injury (TBI) between 1984 and 2015 have been retrospectively analyzed and arranged into cohorts according to the occurrence of complications requiring surgical intervention.ResultsCox regression analysis revealed a lower revision rate in patients with polymethylmethacrylate (PMMA) implants than in patients with autologous calvarial bone (ACB) implants (HR 0.2, 95% CI 0.1 to 1.0, p = 0.04). A similar effect could be observed in the population of patients aged between 18 and 65 years, who had a lower risk to suffer complications requiring surgical treatment than individuals aged under 18 or over 65 years (HR 0.4, 95% CI 0.2 to 0.9, p = 0.02). Revision rates were not influenced by the gender (p = 0.88), timing of the CP (p = 0.53), the severity of the TBI (p = 0.86), or the size of the cranial defect (p = 0.16).ConclusionsIn this study, the implant material and patient age were identified as the most relevant parameters independently predicting the long-term outcome of secondary CP. The use of PMMA was associated with lower revision rates than ACB and might provide a therapeutic benefit for selected patients with traumatic cranial defects.
Highlights
Decompressive craniectomy (DC) is a potentially life-saving procedure performed with the objective of relieving critically raised intracranial pressure (ICP) [1]
decompressive craniectomy (DC) was performed in 22 patients for indications other than severe traumatic brain injury (TBI)
PMMA was chosen more frequently in patients with smaller cranial defects than autologous calvarial bone (ACB), but less frequently in patients aged more than 65 years
Summary
Decompressive craniectomy (DC) is a potentially life-saving procedure performed with the objective of relieving critically raised intracranial pressure (ICP) [1]. The necessity of opening the skull arises from a malignant brain swelling following severe traumatic brain injury (TBI). The use of DC remains controversial as it is associated with worse neurological outcomes than a conservative ICP management if performed routinely but might provide a therapeutic benefit for individually selected patients [2, 3]. Secondary cranioplasty (CP) is considered to support the neurological recovery of patients after decompressive craniectomy (DC), but the treatment success might be limited by complications associated to confounders, which are not yet fully characterized. Methods Data from 156 patients who received secondary CP following DC for severe traumatic brain injury (TBI) between 1984 and 2015 have been retrospectively analyzed and arranged into cohorts according to the occurrence of complications requiring surgical intervention
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