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      Review of Cranioplasty after Decompressive Craniectomy

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          Abstract

          Cranioplasty is an in evitable operation conducted after decompressive craniectomy (DC). The primary goals of cranioplasty after DC are to protect the brain, achieve a natural appearance and prevent sinking skin flap syndrome (or syndrome of the trephined). Furthermore, restoring patients' functional outcome and supplementing external defects helps patients improve their self-esteem. Although early cranioplasty is preferred in recent year, optimal timing for cranioplasty remains a controversial topic. Autologous bone flaps are the most ideal substitute for cranioplasty. Complications associated with cranioplasty are also variable, however, post-surgical infection is most common. Many new materials and techniques for cranioplasty are introduced. Cost-benefit analysis of these new materials and techniques can result in different outcomes from different healthcare systems.

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          Outcomes of cranioplasty with synthetic materials and autologous bone grafts.

          Jaakko M Piitulainen, Tommi Kauko, Kalle M. J. Aitasalo … (2015)
          Using current surgical methods, cranioplasty is associated with a high complication rate. We analyzed if there are preexisting medical conditions associated with complications and compared the effect of different implant materials on the degree of complications.
          Article 0 comments Cited 49 times – based on 0 reviews     Review now
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            Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head trauma.

            Yang Xiaofeng, Li Gu, Liu Weiguo … (2007)
            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.
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              A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty.

              Stephen Honeybul, David Morrison, Kwok M Ho … (2017)
              OBJECTIVE Autologous bone is usually used to reconstruct skull defects following decompressive surgery. However, it is associated with a high failure rate due to infection and resorption. The aim of this study was to see whether it would be cost-effective to use titanium as a primary reconstructive material. METHODS Sixty-four patients were enrolled and randomized to receive either their own bone or a primary titanium cranioplasty. All surgical procedures were performed by the senior surgeon. Primary and secondary outcome measures were assessed at 1 year after cranioplasty. RESULTS There were no primary infections in either arm of the trial. There was one secondary infection of a titanium cranioplasty that had replaced a resorbed autologous cranioplasty. In the titanium group, no patient was considered to have partial or complete cranioplasty failure at 12 months of follow-up (p = 0.002) and none needed revision (p = 0.053). There were 2 deaths unrelated to the cranioplasty, one in each arm of the trial. Among the 31 patients who had an autologous cranioplasty, 7 patients (22%) had complete resorption of the autologous bone such that it was deemed a complete failure. Partial or complete autologous bone resorption appeared to be more common among young patients than older patients (32 vs 45 years old, p = 0.013). The total cumulative cost between the 2 groups was not significantly different (mean difference A$3281, 95% CI $-9869 to $3308; p = 0.327). CONCLUSIONS Primary titanium cranioplasty should be seriously considered for young patients who require reconstruction of the skull vault following decompressive craniectomy. Clinical trial registration no.: ACTRN12612000353897 ( anzctr.org.au ).
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Neurotrauma
                Journal ID (iso-abbrev): Korean J Neurotrauma
                Journal ID (publisher-id): KJN
                Title: Korean Journal of Neurotrauma
                Publisher: Korean Neurotraumatology Society
                ISSN (Print): 2234-8999
                ISSN (Electronic): 2288-2243
                Publication date (Print): April 2017
                Publication date (Electronic): 30 April 2017
                Volume: 13
                Issue: 1
                Pages: 9-14
                Affiliations
                Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea.
                Author notes
                Address for correspondence: Suk Hyung Kang. Department of Neurosurgery, Spine Center, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, 77 Sakju-ro, Chuncheon 24253, Korea. Tel: +82-33-240-5173, Fax: +82-33-242-9970, nscharisma@ 123456hanmail.net
                Article
                DOI: 10.13004/kjnt.2017.13.1.9
                PMC ID: 5432454
                PubMed ID: 28512612
                SO-VID: 615f5808-e11c-4f85-aa96-c0a50021763a
                Copyright © Copyright © 2017 Korean Neurotraumatology Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 22 January 2017
                Date revision received : 17 April 2017
                Date accepted : 19 April 2017
                Funding
                Funded by: Rural Development Administration, CrossRef http://dx.doi.org/10.13039/501100003627;
                Award ID: PJ01121401
                Funded by: Hallym University Medical Center, CrossRef http://dx.doi.org/10.13039/501100007551;
                Award ID: HURF 2015-42
                Categories
                Subject: Review Article

                Keywords: cranioplasty,cost-benefit analysis,complications,cosmetics,outcome
                Data availability:
                Keywords: cranioplasty, cost-benefit analysis, complications, cosmetics, outcome

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