Abstract
Background:The optimal timing of cranioplasty after decompressive craniectomy for trauma is unknown. The aim of this study was to determine if early cranioplasty after decompressive craniectomy for trauma reduces complications.Methods:Consecutive cases of patients who underwent autologous cranioplasty after decompressive craniectomy for trauma at a single Level I Trauma Center were studied in a retrospective 10 year data review. Associations of categorical variables were compared using Chi-square test or Fisher's exact test.Results:A total of 157 patients were divided into early (<12 weeks; 78 patients) and late (≥12 weeks; 79 patients) cranioplasty cohorts. Baseline characteristics were similar between the two cohorts. Cranioplasty operative time was significantly shorter in the early (102 minutes) than the late (125 minutes) cranioplasty cohort (P = 0.0482). Overall complication rate in both cohorts was 35%. Infection rates were lower in the early (7.7%) than the late (14%) cranioplasty cohort as was bone graft resorption (15% early, 19% late), hydrocephalus rate (7.7% early, 1.3% late), and postoperative hematoma incidence (3.9% early, 1.3% late). However, these differences were not statistically significant. Patients <18 years of age were at higher risk of bone graft resorption than patients ≥18 years of age (OR 3.32, 95% CI 1.25-8.81; P = 0.0162).Conclusions:After decompressive craniectomy for trauma, early (<12 weeks) cranioplasty does not alter the incidence of complication rates. In patients <18 years of age, early (<12 weeks) cranioplasty increases the risk of bone resorption. Delaying cranioplasty (≥12 weeks) results in longer operative times and may increase costs.
Highlights
The optimal timing of cranioplasty after decompressive craniectomy for trauma is unknown
Decompressive craniectomy to treat elevated intracranial pressure and evacuate mass lesions associated with head injury has been shown to increase survival.[1,2,5,7,9,12,13,14,20,22]
Case series suggest that early cranioplasty is associated with higher rates of infection while delaying cranioplasty may be Surgical Neurology International 2014, 5:25 associated with higher rates of bone resorption.[4,6,16,21,23]
Summary
The aim of this study was to determine if early cranioplasty after decompressive craniectomy for trauma reduces complications. We aimed to determine if the timing of cranioplasty after decompressive craniectomy for trauma alters rates of complications
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