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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Timing of cranioplasty after decompressive craniectomy regarding postoperative complications

Meeting Abstract

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  • P. Schuss - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Frankfurt/Main
  • E. Güresir - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Frankfurt/Main
  • L. Imöhl - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Frankfurt/Main
  • C.T. Ulrich - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Frankfurt/Main
  • H. Vatter - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Frankfurt/Main
  • V. Seifert - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Frankfurt/Main

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.05.06

doi: 10.3205/11dgnc131, urn:nbn:de:0183-11dgnc1319

Published: April 28, 2011

© 2011 Schuss et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Decompressive craniectomy (DC) for intractable intracranial pressure mandates later cranioplasty (CP). Despite possible residual brain swelling after DC, several previous reports suggested an early performed CP in order to achieve a better neurological outcome. However, the timing of CP after DC remains still controversial. We therefore analyzed our prospectively conducted database concerning timing of CP and associated postoperative complications.

Methods: From October 1999 to January 2010, cranioplasty was performed 212 times at the authors' institution. Patients were divided into two groups according to the time to cranioplasty (≤ 2 months versus > 2 months). Patient characteristics, timing of CP and CP-related postoperative complications were analyzed.

Results: Overall CP was performed early in 22% vs. late in 78%. Complications after CP included wound healing disturbance (6.1%), EDH or SDH (4.2%), abscess (1.9%), hygroma (1.4%), CSF fistula (0.9%), and other (0.9%). The overall complication rate was 15.6%. Patients with VP shunt had a significant higher rate of complications after CP compared to patients without VP shunt (p=0.004). Patients, who underwent CP early after DC, suffered significantly more often from complications compared to patients, who underwent CP late after initial DC (25.5% vs. 12.7%; p=0.04). On multivariate analysis, early CP, presence of VP shunt and ICH as underlying pathology were significant predictors of postoperative complications after CP.

Conclusions: We provide detailed data on surgical timing and complication for cranioplasty after DC. The present data suggest that patients with CP performed more than 2 months after DC might benefit from a lower complication rate.