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Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head
Wen Liang1, Yang Xiaofeng, Liu Weiguo
1Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China.
Insights
Early cranioplasty (5-8 weeks) after decompressive craniectomy for large cranial defects improves neurological function and outcomes. This procedure is safe and beneficial for patient recovery and prognosis, with no reported deaths or infections.
Area of Science:
- Neurosurgery
- Trauma Surgery
Background:
- Decompressive craniectomy for refractory intracranial hypertension can result in large cranial defects.
- Delayed cranioplasty (typically 3 months) may hinder early patient rehabilitation due to complications associated with large cranial defects.
Purpose of the Study:
- To evaluate the safety and efficacy of early cranioplasty (5-8 weeks post-craniotomy) for large cranial defects.
- To assess the impact of early cranioplasty on neurological function, complications, and long-term prognosis in head trauma patients.
Main Methods:
- Retrospective review of 23 patients who underwent early cranioplasty.
- Detailed patient selection, complication assessment, and prognosis evaluation.
- Follow-up at 1 month (early outcome) and 18 months (long-term prognosis).
Main Results:
- Most patients with pre-existing conscious disturbance recovered consciousness and showed improved neurological function by 1 month post-cranioplasty.
- At 18 months, 74% of patients had a good prognosis (independent), 17% survived with severe disability, and 9% remained in a vegetative state.
- Complications related to the cranial defect were relieved, with symptom and CT scan improvements observed.
Conclusions:
- Early cranioplasty for large cranial defects following decompressive craniectomy is safe and beneficial when patients and materials are appropriately selected.
- The procedure aids in improving neurological function and patient prognosis.
- This study may be the first detailed English report on early cranioplasty after decompressive craniectomy.
Abstract:
Large cranial defects resulting from decompressive craniectomy performed for refractory intracranial hypertension after head trauma is one of the indications for cranioplasty, and this procedure is commonly performed 3 months after craniectomy. However, the large cranial defect would lead to the kinds of complications early during the phase of these patients' recovery, which would go against rehabilitation. This study retrospectively reviewed 23 patients undergoing early cranioplasty (5-8 weeks after craniectomy) in the last 4 years with a detailed choice of patients, outcome of complications after head trauma and large craniectomy, as well as assessment of prognosis. The early outcome (1 month later) revealed most of the patients who had conscious disturbance before the cranioplasty recovered their consciousness and presented an improved neurologic function. The long-dated prognosis (18 months later) revealed that 17 patients were good (independent patients) in this series (74%), whereas four patients survived with a severe disability (17%) and two remained in a vegetative state (9%). No dead patients or intracranial infection after the procedure were found in this study. Most patients' complications were relieved after the cranioplasty with improvements of symptoms or image of computed tomography scan. In conclusion, we consider that with the appropriate choice of patients and materials, early cranioplasty for large cranial defects after decompressive craniectomy would be safe and helpful for the improvement of patients' neurologic function and prognosis. To our knowledge, this series may be the first detailed report in English about early cranioplasty after decompressive craniectomy. We are going to perform prospective and retrospective contrastive studies to further confirm the effects of this procedure on the patients with large cranial defects after decompressive craniectomy.
