Cranioplasty following decompressive craniectomy in traumatic brain injury: Experience at Level - I apex trauma centre

Abstract

Complications after cranioplasty following decompressive craniectomy are often underreported. A review of the complications helps to suggest measures to improve the care of these patients. We provide a review of all complications of cranioplasty with autologous or synthetic materials in this article. All patients who had undergone cranioplasty following decompressive craniectomy at JPN Apex trauma centre, AIIMS from Jan 2008 till 2010 April were included in the study. Demographic data, indications for craniectomy, materials used, methods of autologous bone storage and all perioperative complications were recorded. Total 114 patients were studied. Mean duration between decompressive craniectomy and cranioplasty was 207.6 ± 28.2 days (Mean ± SD) with a range of 50 to 840 days. The overall postoperative complication rate was 23% (26/114) of which 16 patients (14 %) had to undergo reoperation after cranioplasty. Bone flap infection was the commonest accounting for 10 (62.5 %) of the reoperations. Even though considered as simple procedure, cranioplasty is associated with significant complications requiring reoperation. There was no correlation of complications or need for reoperation with type of materials, storage of the bone or timing of surgery. A seemingly smaller neurosurgical operation requires good surgical approach to minimize morbidity associated with cranioplasty.

Keywords

Cranioplasty - decompressive craniectomy - severe head injury

^* Paper presented in the award paper session during 18^th National Neurotrauma Conference held at Chennai, 20-22 Aug 2010.

• References

• 1 Hutchinson PJ, Corteen E, Czosnyka M. et al Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUE icp study www.RESCUEicp.com. Acta Neurochir Suppl (Wien) 2006; 96: 17-20
• 2 Jüttler E, Schwab S, Schmiedek P. et al Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke 2007; 38: 2518-2525
• 3 Azmi A, Latiff AZ, Johari A. Methyl methacrylate cranioplasty. Med J Malaysia 2004; 59: 418-421
• 4 Blum KS, Schneider SJ, Rosenthal AD. Methyl methacrylate cranioplasty in children: long-term results. Pediatr Neurosurg 1997; 26: 33-35
• 5 Ducic Y. Titanium mesh and hydroxyapatite cement cranioplasty: a report of 20 cases. J Oral Maxillofac Surg 2002; 60: 272-276
• 6 Durham SR, McComb JG, Levy ML. Correction of large (>25 cm) cranial defects with “reinforced” hydroxyapatite cement: technique and complications. Neurosurgery 2003; 52: 842-845
• 7 Foster RD, Antonyshyn OM, Lee C, Holland M, Fazl M. Cranioplasty: Indications, techniques, and results. in Schmidek HH. (ed) Schmidek and Sweet Operative Neurosurgical Techniques. WB Saunders; Philadelphia: 2000: 29-44
• 8 Kuo JR, Wang CC, Chio CC, Cheng TJ. Neurological improvement after cranioplasty—analysis by transcranial Doppler ultrasonography. J Clin Neurosci 2004; 11: 486-489
• 9 Segal DH, Oppenheim JS, Murovic JA. Neurological recovery after cranioplasty. Neurosurgery 1994; 34: 729-731
• 10 Suzuki N, Suzuki S, Iwabuchi T. Neurological improvement after cranioplasty. Analysis by dynamic CT scan. Acta Neurochir (Wien) 1993; 122: 49-53
• 11 Petty PG. Cranioplasty: a follow-up study. Med J Aust 1974; 02: 806-808
• 12 Gooch MR, Gin GE, Kenning TJ, German JW. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 2009; 26 (06) E9
• 13 Matsuno A, Tanaka H, Iwamuro H. et al Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochir (Wien) 2006; 148: 535-540
• 14 Movassaghi K, Ver Halen J, Ganchi P, Amin-Hanjani S, Mesa J, Yaremchuk MJ. Cranioplasty with subcutaneously preserved autologous bone grafts. Plast Reconstr Surg 2006; 117: 202-206
• 15 Osawa M, Hara H, Ichinose Y, Koyama T, Kobayashi S, Sugita Y. Cranioplasty with a frozen and autoclaved bone flap. Acta Neurochir (Wien) 1990; 102: 38-41
• 16 Paþaoðlu A, Kurtsoy A, Koc RK. et al Cranioplasty with bone flaps preserved under the scalp. Neurosurg Rev 1996; 19: 153-156
• 17 Rish BL, Dillon JD, Meirowsky AM. et al Cranioplasty: a review of 1030 cases of penetrating head injury. Neurosurgery 1979; 04: 381-385