Artikel
Randomised evaluation of early vs late cranioplasty investigating cognitive and functional recovery: protocol for a single centre, pilot, randomised trial
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Autoren
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Harry Mee
- Cambridge University, Cambridge, United Kingdom
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Angelos Kolias
- Cambridge University, Cambridge, United Kingdom
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Fahim Anwar
- Cambridge Hospital NHS Trust, Cambridge, United Kingdom
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Ivan Timofeev
- Cambridge Hospital NHS Trust, Cambridge, United Kingdom
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Adel Helmy
- Cambridge University, Cambridge, United Kingdom
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Carole Turner
- Cambridge University, Cambridge, United Kingdom
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Karen Caldwell
- Cambridge Hospital NHS Trust, Cambridge, United Kingdom
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Sylvia Tarantino
- Cambridge Hospital NHS Trust, Cambridge, United Kingdom
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Georgina Browne
- Cambridge Hospital NHS Trust, Cambridge, United Kingdom
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Emma Woodbury
- Cambridge Hospital NHS Trust, Cambridge, United Kingdom
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Barbara Gregson
- University of Newcastle upon Tyne, Newcastle, United Kingdom
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Elizabeth Warburton
- Cambridge Hospital NHS Trust, Cambridge, United Kingdom
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Peter Hutchinson
- Cambridge University, Cambridge, United Kingdom
| Veröffentlicht: | 16. April 2019 |
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Gliederung
Text
Background: Patients with significant brain swelling and/or raised intracranial pressure after a traumatic brain injury (TBI) or middle cerebral artery infarct (MCA infarct) can undergo a craniectomy [1], [2] to help in the management of raised intracranial pressures. Those who survive require a second operation a few months later in order to have their skull reconstructed. This operation, which is termed cranioplasty, aims to restore the integrity of the skull. Apart from the obvious benefit of restoring a degree of mechanical protection to the brain, there is a growing body of evidence showing improvements in neurological function and cognition [3]. There is some limited evidence that an early cranioplasty can enhance this effect.
Aim: To compare two distinct time intervals for undertaking a cranioplasty: early (within 3 months after craniectomy) vs late (more than 6 months after craniectomy) and comparing neurosurgical complications as well as cognitive differences, functional improvements, and QOL variations.
Method: A single centre, pilot, internal, randomised trial is recruiting up to 50 patients in 2019. Time point ‘0’ is at craniectomy; Neurocognitive testing, functional and QOL assessments in addition to monitoring neurosurgical complications are being undertaken at 2, 6, 12 and 18 months post craniectomy.
Discussion and conclusions: This is a protocol for a randomised trial to try and better understand the optimal time for a cranioplasty to help improve the rehabilitation of patients who have undergone a craniectomy after a TBI or MCA infarct.
References
- 1.
- Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, et al. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. The New England Journal of Medicine. 2016 Sep 22;375(12):1119-30.
- 2.
- Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. The Lancet Neurology. 2007 Mar;6(3):215-22.
- 3.
- Malcolm JG, Rindler RS, Chu JK, Chokshi F, Grossberg JA, Pradilla G, et al. Early Cranioplasty is Associated with Greater Neurological Improvement: A Systematic Review and Meta-Analysis. Neurosurgery. 2018 Mar;82(3):278-88.
