gms | German Medical Science

Objective: Decompressive craniectomy (DC) requires later cranioplasty (CP) in survivors. However, if additional ventriculoperitoneal shunt (VPS) placement due to shunt-dependent hydrocephalus is necessary in these patients, the optimal timing of the two procedures still remains controversial. We therefore analyzed our computerized database concerning the timing of CP and VPS regarding postoperative complications.

Method: From 2009 to 2014, 41 cranioplasty procedures with simultaneous (during the same procedure) or staged VPS placement were performed at the authors' institution. Patients were stratified into two groups according to the time from CP to VPS ("simultaneous" and "staged"). Patient characteristics, timing of CP and VPS, as well as procedure-related complications were assessed and analyzed.

Results: Overall CP and VPS were performed simultaneously in 17 of 41 patients (41%) and in staged fashion in 24 of 41 patients (59%). The overall complication rate of CP and VPS was 27%. Patients who underwent simultaneous CP and VPS placement suffered significantly more often from complications compared to patients who underwent staged CP and VPS procedures (47% vs. 12%; p=0.03). Patients with simultaneous CP and VPS had a significantly higher rate of infectious postoperative complications compared to patients with staged procedures (p=0.003). On multivariate analysis, simultaneous CP and VPS procedure was the only significant predictor of postoperative complications after CP and VPS (p=0.03).

Conclusions: We provide detailed data on surgical timing and complications for cranioplasty and ventriculoperitoneal shunt placement after DC. The present data suggests that patients who undergo staged CP and VPS procedures might benefit from a lower complication rate. This might influence future surgical decision-making regarding optimal timing of CP and VPS placement.