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J Neuroanaesth Crit Care 2018; 05(01): S1-S27
DOI: 10.1055/s-0038-1636415
Abstracts
Thieme Medical and Scientific Publishers Private Limited

Perioperative Management and Functional Outcome Post Cranioplasty: A Retrospective Observational, Single Institutional Study

Swayam Tara
1   Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
,
Vidhu Bhatnagar
1   Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
,
Deepak Dwivedi
1   Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
,
S. G. S. Datta
2   Department of Surgery, INHS Asvini, Mumbai, Maharashtra, India
,
A. A. Karmakar
1   Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
› Author Affiliations
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Publication History

Publication Date:
09 February 2018 (online)

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Keywords

Cranioplasty - CVA - TBI

Introduction: Patients with an acute increase in intracranial pressure (ICP) due to cerebrovascular accident (CVA) or traumatic brain injury (TBI) undergo decompressive craniectomy. The surviving patients then undergo cranioplasty procedure in future for rehabilitation by having a positive effect on the cerebrospinal fluid (CSF) dynamics. A high rate of perioperative complications is associated with this procedure. We conducted a retrospective analysis of the cranioplasty surgeries which took place in our center.

Methodology/Description: After taking permission from the Institute Review Board, data was collected from the Anesthesia and Neurosurgery registers from June 2016 to June 2017. A retrospective analysis was performed.

Results: The overall complication rate found was 6.6%. Cranioplasties were done post craniectomies for TBI in 60% of cases and post-CVA in 40% of cases. Sixty-six percent of cranioplasties were with acrylic, 20% with autologous bone, and 13.3% with titanium plates. The only complication encountered intraoperatively was seizure in one patient. No deaths were noted. One patient developed deterioration in the Glasgow Coma Scale on the third postoperative day and had to undergo removal of the acrylic bone. The functional outcomes post cranioplasty were similar to presurgical status.

Conclusion: Cranioplasty appears as an easy surgical procedure but may have a complication rate as high as 41% which is in direct contrast to the complication rate for the routine neurosurgical procedures. Our results show 6.6% complication rate because preventable complications were avoided by optimal preparation perioperatively. The results also indicate that synthetic implants may be utilized in patients with irretrievable bone flaps or delayed time to cranioplasty.


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  • References

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  • References

  • 1 Dwivedi D, Bhatnagar V, Kiran S, Ray A. Intraoperative seizures during redo cranioplasty for sinking skin flap syndromerole of BIS™ monitor in detection.. Saudi J Anaesth 2017; 11 (03) 359-360
    CrossrefPubMedSearch in Google Scholar
  • 2 Wachter D, Reineke K, Behm T, Rohde V. Cranioplasty after decompressive hemicraniectomy: underestimated surgery-associated complications?. Clin Neurol Neurosurg 2013; 115 (08) 1293-1297
    CrossrefPubMedSearch in Google Scholar

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