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Clinical Outcomes After Ultra-Early Cranioplasty Using Craniectomy Contour Classification as a Patient Selection
Pious D Patel1, Omaditya Khanna1, M Reid Gooch1
1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Insights
Ultra-early cranioplasty (0-6 weeks) is a viable option with no increased complication rates. This timing may improve functional independence in select patients, guided by the novel craniectomy contour classification (CCC).
Area of Science:
- Neurosurgery
- Surgical Outcomes
- Patient Selection
Background:
- Cranioplasty, while not technically complex, carries a high complication rate.
- Optimal timing for cranioplasty to minimize complications is debated.
- Patient selection and timing are critical for successful cranioplasty outcomes.
Purpose of the Study:
- To compare cranioplasty outcomes across ultra-early (0-6 weeks), intermediate (6 weeks-6 months), and late (>6 months) time frames.
- To introduce and evaluate a novel craniectomy contour classification (CCC) for assessing surgical readiness.
Main Methods:
- Retrospective analysis of 119 patients undergoing cranioplasty.
- Patients stratified into ultra-early, intermediate, and late cranioplasty groups.
- Development of CCC scores (A, B, C) based on radiographic parenchymal contour.
Main Results:
- No significant differences in major complications (e.g., reoperation, infection, seizures) were observed between timing groups.
- Ultra-early cranioplasty showed a trend towards higher functional independence, though not statistically significant after adjustment.
- The craniectomy contour classification (CCC) was introduced as a radiographic assessment tool.
Conclusions:
- Ultra-early cranioplasty is a safe and viable option in carefully selected patients.
- Timing does not appear to significantly impact complication rates.
- The CCC system may aid in clinical decision-making regarding the optimal timing for cranioplasty.
Background:
Although not a technically difficult operation, cranioplasty is associated with high rates of complications. The optimal timing of cranioplasty to mitigate complications remains the subject of debate.
Objective:
To report outcomes between patients undergoing cranioplasty at ultra-early (0-6 weeks), intermediate (6 weeks to 6 months), and late (>6 months) time frames. We report a novel craniectomy contour classification (CCC) as a radiographic parameter to assess readiness for cranioplasty.
Methods:
A single-institution retrospective analysis of patients undergoing cranioplasty was performed. Patients were stratified into ultra-early (within 6 weeks of index craniectomy), intermediate (6 weeks to 6 months), and late (>6 months) cranioplasty cohorts. We have devised CCC scores, A, B, and C, based on radiographic criteria, where A represents those with a sunken brain/flap, B with a normal parenchymal contour, and C with "full" parenchyma.
Results:
A total of 119 patients were included. There was no significant difference in postcranioplasty complications, including return to operating room ( P = .212), seizures ( P = .556), infection ( P = .140), need for shunting ( P = .204), and deep venous thrombosis ( P = .066), between the cohorts. Univariate logistic regression revealed that ultra-early cranioplasty was significantly associated with higher rate of functional independence at >6 months (odds ratio 4.32, 95% CI 1.39-15.13, P = .015) although this did not persist when adjusting for patient selection features (odds ratio 2.90, 95% CI 0.53-19.03, P = .234).
Conclusion:
In appropriately selected patients, ultra-early cranioplasty is not associated with increased rate of postoperative complications and is a viable option. The CCC may help guide decision-making on timing of cranioplasty.
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