Early versus Late Cranioplasty after Decompressive Craniectomy

Introduction: Cranioplasty after decompressive craniectomy (DC) is a standard procedure performed to pursue rehabilitation. Optimal timing for this intervention remains unclear.

Methods: We retrospectively analyzed all patients who underwent unilateral frontotemporoparietal or bifrontal DC for intracranial hypertension in our institution from January 2007 to December 2010 (n = 112). Of these 54 patients underwent cranioplasty in our institution, owing to transfer to another center or prior death. We separated patients in two groups: early (≤1 month) and late (>1 month) cranioplasty. We recorded timing to cranioplasty in days, as well as intervention time. Main postoperative complications were obtained for every patient. Follow-up was evaluated with extended Glasgow Outcome Scale (eGOS).

Results: Mean time to cranioplasty was 86 days (±SD 56 days). Of the 54, 12 patients (22%) underwent early and 42 patients (78%) underwent late cranioplasty. Mean overall intervention time was 2 hours 7 minutes (±SD 1 hour 01 minute). Mean intervention time in the early cranioplasty group was 1 hour 54 minutes (±SD 1 hour 16 minutes) against 2 hours 11 minutes (±SD 57 minutes) in the late group. Intervention time was significantly lower by mean 15 minutes in the early group (p = 0.028). Main complications were local infection requiring surgical revision in four patients (7.4%), hygroma formation in five (9.3%), and secondary hydrocephalus in three patients (5.6%). Postoperative complications did not differ significantly between the early and late group. Follow-up (mean 6±3 months) eGOS was comparable between the two groups (p = 0.98).

Conclusion: Our data suggest that early cranioplasty in patients having undergone unilateral or bilateral DC may shorten intervention time, thus preventing rehospitalisation. Hence, rehabilitation could take place more efficiently, without exposing patients to increased complication risks such as sinking flap syndrome.