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Outcomes of Cranioplasty from a Tertiary Hospital in a Developing Country
G Lakshmi Prasad1, Girish R Menon1, Lakshman I Kongwad1
1Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Insights
Cranioplasty (CP) complications are reduced when patients have a good neurological state before surgery. Early CP (<12 weeks) showed fewer complications, contradicting previous findings.
Area of Science:
- Neurosurgery
- Surgical Outcomes
- Patient Safety
Background:
- Cranioplasty (CP) is a common procedure following decompressive craniectomy (DC).
- Existing literature presents conflicting evidence regarding the association between early CP and complication rates.
- Understanding factors influencing CP outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To analyze the outcomes of cranioplasty (CP) at a university hospital.
- To identify factors associated with cranioplasty complications.
- To evaluate the impact of CP timing on complication rates.
Main Methods:
- Retrospective analysis of 93 patients undergoing CP over 3 years.
- Data collected included demographics, etiology of DC, CP interval, operative details, and complications.
- Statistical analysis was performed to correlate complications with timing and other patient factors.
Main Results:
- The majority of cases involved traumatic and ischemic stroke etiologies.
- A total of 10 complications (10.7%) were observed, including one death.
- Poor Glasgow Outcome Scale score at CP was the only significant predictor of higher complication rates; early CP (<12 weeks) showed fewer complications.
Conclusions:
- Patient's neurological status pre-CP is a significant factor in complication risk.
- Early CP (<12 weeks) is associated with fewer complications, challenging prior assumptions.
- Implementing specific protocols can potentially minimize cranioplasty-related complications.
Introduction:
Although cranioplasty (CP) is a straightforward procedure, it may result in a significant number of complications. These include infections, seizures, intracranial hematomas, and others. Many reports have stated that early CP is associated with higher complications; however, more recent articles have contradicted this opinion. We intend to share our experience and results on outcomes of CP from our university hospital.
Materials And Methods:
This is a 3-year retrospective analysis of patients undergoing CP. Demographic profile, etiology of decompressive craniectomy (DC), DC-CP interval, operative details, complications, and follow-up data were analyzed. Correlation of complications with timing of CP and other factors was studied to look for statistical significance.
Results:
A.
Abstract:
total of 93 cases were analyzed. The majority were traumatic and ischemic stroke etiologies. There were eight open/compound head injuries (HIs). Eleven were bilateral and the rest unilateral cases. The mean and median CP interval were 8.5 weeks (range 4-28 weeks) and 8 weeks, respectively. All patients received 48 h to up to 5 days of postoperative antibiotics. Ten complications (10.7%) were noted (including one death). Poor Glasgow Outcome Scale at CP was the only statistically significant factor associated with higher complication rates. There was no statistical difference with respect to gender, CP material, and etiology; however, early CP had slightly fewer complications.
Conclusion:
Patients with poor neurological condition at the time of CP have a significantly higher risk of complications. Contrary to earlier reports, early CP (<12 weeks) was not associated with higher complications but rather fewer complications than delayed procedures. Adherence to a few simple steps may help reduce these complications.
