gms | German Medical Science

Objective: Decompressive craniectomy (DC) for malignant stroke mandates subsequent cranioplasty (CP). Despite possible residual brain swelling after DC, several previous reports suggested an early performed CP in terms of better neurological outcome. However, the timing of CP after DC remains still controversial. Patients who underwent DC due to stroke usually present with several co-morbidities and antiplatelet medication, which might influence postoperative complications after CP. Therefore, the aim of this study was to analyze patients who underwent CP due to cerebral infarction concerning timing of CP and associated postoperative complications.

Method: Between 2007 and 2013, CP was performed in 62 patients who previously underwent DC due to cerebral infarction. Patients were divided into two groups according to the time to cranioplasty (≤ 3 months vs. > 3 months). Patient characteristics, timing of CP, and CP-related postoperative complications were analyzed.

Results: Overall, CP was performed early in 16%, and late in 84%. The overall complication rate after CP was 21%. Complications included wound healing disturbance (14.5%), EDH or SDH (4.8%), and other (1.7%). Patients, who underwent CP early after DC, suffered significantly more often from complications compared to patients, who underwent CP late after initial DC (50% vs. 18.2%; p=0.014). In the multivariate analysis, early CP was a significant predictor of postoperative complications after CP in stroke patients who previously underwent DC (OR 5.5; CI 1.3-24.5; p=0,021).

Conclusions: Complications of CP exceed those of other elective cranial procedures. The present data suggests that patients who underwent DC for stroke might benefit from CP performed more than 3 months after DC due to a lower complication rate.