Abstract
Background
Although cranioplasty (CP) is a frequently performed and simple procedure, complications are common, particularly bone flap resorption and infection. The timing of surgery is as an important contributory factor, but the optimal timing has not been clearly determined.
Objective
We retrospectively investigated bone flap resorption and surgical site infection after CP to determine the optimal timing of surgery for reduction of complications.
Methods
The study enrolled 126 patients who underwent decompressive craniectomy (DC) and subsequent CP. Patients with bone flap resorption or surgical site infection were analyzed as the “complication” group. Receiver operating characteristic curve analysis was performed and the Youden index was used to dichotomize “early CP” and “late CP” groups. Univariate and multivariate survival analyses were performed.
Results
The complication group included 42 patients. The Youden index was used to identify a cutoff value for the DC-CP interval of > 44 days, and this was used to define early (< 45 days) and late (≥ 45 days) CP. Late CP was a significant risk factor in univariate and multivariate Cox regression analyses.
Conclusion
This study showed that early CP before 45 days after DC is associated with a lower rate of bone flap resorption and surgical site infection than late CP.
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References
Artico M, Ferrante L, Pastore FS, Ramundo EO, Cantarelli D, Scopelliti D, Iannetti G (2003) Bone autografting of the calvaria and craniofacial skeleton: historical background, surgical results in a series of 15 patients, and review of the literature. Surg Neurol 60:71–79
Ban SP, Son YJ, Yang HJ, Chung YS, Lee SH, Han DH (2010) Analysis of complications following decompressive craniectomy for traumatic brain injury. J Korean Neurosurg Soc 48:244–250
Bender A, Heulin S, Rohrer S, Mehrkens JH, Heidecke V, Straube A, Pfefferkorn T (2013) Early cranioplasty may improve outcome in neurological patients with decompressive craniectomy. Brain Inj 27:1073–1079
Brommeland T, Rydning PN, Pripp AH, Helseth E (2015) Cranioplasty complications and risk factors associated with bone flap resorption. Scand J Trauma Resusc Emerg Med 23:75
Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger JE, Surgical Management of Traumatic Brain Injury Author G (2006) Surgical management of acute subdural hematomas. Neurosurgery 58:S16–S24 discussion Si-iv
Chang V, Hartzfeld P, Langlois M, Mahmood A, Seyfried D (2010) Outcomes of cranial repair after craniectomy. J Neurosurg 112:1120–1124
Fan MC, Wang QL, Sun P, Zhan SH, Guo P, Deng WS, Dong Q (2018) Cryopreservation of autologous cranial bone flaps for cranioplasty: a large sample retrospective study. World Neurosurg 109:e853–e859
Hng D, Bhaskar I, Khan M, Budgeon C, Damodaran O, Knuckey N, Lee G (2015) Delayed cranioplasty: outcomes using frozen autologous bone flaps. Craniomaxillofac Trauma Reconstr 8:190–197
Honeybul S (2010) Complications of decompressive craniectomy for head injury. J Clin Neurosci 17:430–435
Kim JS, Cheong JH, Ryu JI, Kim JM, Kim CH (2015) Bone flap resorption following cranioplasty after decompressive craniectomy: preliminary report. Korean J Neurotrauma 11:1–5
Liang W, Xiaofeng Y, Weiguo L, Gang S, Xuesheng Z, Fei C, Gu L (2007) Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head trauma. J Craniofac Surg 18:526–532
Lu Y, Hui G, Liu F, Wang Z, Tang Y, Gao S (2012) Survival and regeneration of deep-freeze preserved autologous cranial bones after cranioplasty. British J Neurosurg 26:216–221
Malcolm JG, Rindler RS, Chu JK, Grossberg JA, Pradilla G, Ahmad FU (2016) Complications following cranioplasty and relationship to timing: a systematic review and meta-analysis. J Clin Neurosci 33:39–51
Malcolm JG, Rindler RS, Chu JK, Chokshi F, Grossberg JA, Pradilla G, Ahmad FU (2017) Early cranioplasty is associated with greater neurological improvement: a systematic review and meta-analysis. Neurosurgery 82:278–288
Martin KD, Franz B, Kirsch M, Polanski W, von der Hagen M, Schackert G, Sobottka SB (2014) Autologous bone flap cranioplasty following decompressive craniectomy is combined with a high complication rate in pediatric traumatic brain injury patients. Acta Neurochir 156:813–824
Morton RP, Abecassis IJ, Hanson JF, Barber JK, Chen M, Kelly CM, Nerva JD, Emerson SN, Ene CI, Levitt MR, Chowdhary MM, Ko AL, Chesnut RM (2017) Timing of cranioplasty: a 10.75-year single-center analysis of 754 patients. J Neurosurg 128:1648–1652
Paredes I, Castano-Leon AM, Munarriz PM, Martinez-Perez R, Cepeda S, Sanz R, Alen JF, Lagares A (2015) Cranioplasty after decompressive craniectomy. A prospective series analyzing complications and clinical improvement. Neurocirugia 26:115–125
Piedra MP, Thompson EM, Selden NR, Ragel BT, Guillaume DJ (2012) Optimal timing of autologous cranioplasty after decompressive craniectomy in children. J Neurosurg Pediatr 10:268–272
Piedra MP, Nemecek AN, Ragel BT (2014) Timing of cranioplasty after decompressive craniectomy for trauma. Surg Neurol Int 5:25
Quah BL, Low HL, Wilson MH, Bimpis A, Nga VDW, Lwin S, Zainuddin NH, Wahab NA, Salek MAA (2016) Is there an optimal time for performing cranioplasties? Results from a prospective multinational study. World Neurosurg 94:13–17
Ruopp MD, Perkins NJ, Whitcomb BW, Schisterman EF (2008) Youden index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom J 50:419–430
Schoekler B, Trummer M (2014) Prediction parameters of bone flap resorption following cranioplasty with autologous bone. Clin Neurol Neurosurg 120:64–67
Schuss P, Vatter H, Oszvald A, Marquardt G, Imohl L, Seifert V, Guresir E (2013) Bone flap resorption: risk factors for the development of a long-term complication following cranioplasty after decompressive craniectomy. J Neurotrauma 30:91–95
Stieglitz LH, Fung C, Murek M, Fichtner J, Raabe A, Beck J (2015) What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients. Acta Neurochir 157:275–280
Tsang AC, Hui VK, Lui WM, Leung GK (2015) Complications of post-craniectomy cranioplasty: risk factor analysis and implications for treatment planning. J Clin Neurosci 22:834–837
Yang NR, Song J, Yoon KW, Seo EK (2018) How early can we perform cranioplasty for traumatic brain injury after decompressive craniectomy? A retrospective multicenter study. World Neurosurg 110:e160–e167
Acknowledgements
This was supported by Korea University Grant.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee [2017GR0098] and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Kim, J.H., Hwang, SY., Kwon, TH. et al. Defining “early” cranioplasty to achieve lower complication rates of bone flap failure: resorption and infection. Acta Neurochir 161, 25–31 (2019). https://doi.org/10.1007/s00701-018-3749-8
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DOI: https://doi.org/10.1007/s00701-018-3749-8