Safety and Efficacy of Early Cranioplasty after Decompressive Craniectomy in Traumatic Brain Injury Patients

Large cranial defects can result from decompressive craniectomy performed for rapid relief of intractable intracranial hypertension. Decompressive craniectomy reduces the risk of death in patients experiencing severe brain edema. However, patients with large cranial defects may experience complications, including sinking flap syndrome and syndrome of the trephined. A large cranial defect is one of the indications for cranioplasty, and, according to prior practice, this procedure is commonly performed 3-6 months after craniectomy because of infection risks or unresolved brain swelling. Recently, the purpose of cranioplasty has changed, from cosmetic or protective effects to therapeutic effects. We performed early cranioplasty in an effort to diminish complications from large cranial defects. The aim of this study was to assess the safety and efficacy of early cranioplasty after decompressive craniectomy. Considering the hospitalization periods and complications that proceed from large cranial defects, another goal of this study is the prompt reintegration of these patients into their normal living environments.

[1]  A. Sharan,et al.  Effect of Early Surgery, Material, and Method of Flap Preservation on Cranioplasty Infections: A Systematic Review , 2011, Neurosurgery.

[2]  H. Yi,et al.  Efficacy and Safety of Early Cranioplasty, At Least Within 1 Month , 2011, The Journal of craniofacial surgery.

[3]  Guo-liang Zhang,et al.  Extensive duraplasty with autologous graft in decompressive craniectomy and subsequent early cranioplasty for severe head trauma. , 2010, Chinese journal of traumatology = Zhonghua chuang shang za zhi.

[4]  A. Sauaia,et al.  Cranioplasty after postinjury decompressive craniectomy: is timing of the essence? , 2010, The Journal of trauma.

[5]  Jen-Tsung Yang,et al.  Factors affecting graft infection after cranioplasty , 2008, Journal of Clinical Neuroscience.

[6]  Y. Xiaofeng,et al.  Cranioplasty of Large Cranial Defect at an Early Stage After Decompressive Craniectomy Performed for Severe Head Trauma , 2007, The Journal of craniofacial surgery.

[7]  M. N. Carvi y Nievas,et al.  Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders , 2006, Neurological research.

[8]  Hiroaki Nakazawa,et al.  Sinking Skin Flap Syndrome: A Case of Improved Cerebral Blood Flow After Cranioplasty , 2004, Annals of plastic surgery.

[9]  杨学军,et al.  Complications induced by decompressive craniectomies after traumatic brain injury , 2003 .

[10]  B. Eppley.  Influence of Cranioplasty on Postural Blood Flow Regulation, Cerebrovascular Reserve Capacity, and Cerebral Glucose Metabolism , 2001 .

[11]  K. Krishnan,et al.  Influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism. , 2000, Journal of neurosurgery.

[12]  L. Pollak,et al.  Symptomatic patients after craniectomy. , 1997, Surgical neurology.

[13]  M Dujovny,et al.  Cranioplasty: cosmetic or therapeutic? , 1997, Surgical neurology.

[14]  J. Murovic,et al.  Neurological recovery after cranioplasty. , 1994, Neurosurgery.

[15]  H. Fodstad,et al.  CSF hydrodynamic studies before and after cranioplasty. , 1979, Acta neurochirurgica. Supplementum.

[16]  A. Yamaura,et al.  Neurological deficits in the presence of the sinking skin flap following decompressive craniectomy. , 1977, Neurologia medico-chirurgica.