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KMID : 1143720110070020074
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Korean Journal of Neurotrauma
2011 Volume.7 No. 2 p.74 ~ p.77
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Safety and Efficacy of Early Cranioplasty after Decompressive Craniectomy in Traumatic Brain Injury Patients
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Cho Kwang-Chun
Park Sung-Choon
Choe Il-Seung
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Abstract
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ObjectivesPatients with large cranial defects after decompressive craniectomy have suffered from complications, including sinking flap syndrome and syndrome of the trephined. A large cranial defect is one of the indications for cranioplasty, and recently, early cranioplasty has been advanced. To assess the safety and efficacy of early cranioplasty, we performed early cranioplasty.
Methods:From January 2009 to December 2010, a total of 36 patients who underwent cranioplasty were enrolled in this study. Group I included 15 patients who underwent early cranioplasty within 6 weeks. Group II included 21 patients who underwent delayed cranioplasty 6 weeks after decompressive craniectomy. In all patients, brain computed tomographic (CT) scans were performed and laboratory results were checked for identification of infections. Duraplasty with artificial dura, use of polymethylmethacrylate (PMMA) for reconstruction, and fixation materials were checked in order to evaluate the effect on complication after the cranioplasty procedure. Outcomes of the procedure were evaluated 1 month after cranioplasty using the Barthel index of activity of daily living (ADL). To evaluate the safety of early cranioplasty, we compared the ratio of infection, subdural fluid collection, and ventricle dilatation in the early cranioplasty group (Group I) and the delayed cranioplasty group (Group II).
Results:Mean periods between decompressive craniectomy and cranioplasty of Groups I and II were 35.20±3.76 (29-42) and 62.95±14.82 (44-102) days. Mean Barthel indexes of ADL about 1 month after cranioplasty in Groups I and II were 65.67±5.30 (55-75) and 47.86±10.67 (30-75). Differences between the two groups were statistically significant (p<0.05). None of the patients suffered surgery related complications during the follow-up period.
Conclusion:We suggest that with appropriate selection of patients, early cranioplasty for large cranial defects after decompressive craniectomy would be safe and helpful for improvement of neurologic function of patients with severe traumatic brain injury.
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KEYWORD
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Early cranioplasty, Decompressive craniectomy
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