Timing of cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke

Clinical article

Mark P. Piedra, Brian T. Ragel, Aclan Dogan, Nicholas D. Coppa, Johnny B. Delashaw

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Object. The optimal timing of cranioplasty after decompressive craniectomy for stroke is not known. Case series suggest that early cranioplasty is associated with higher rates of infection while delaying cranioplasty may be associated with higher rates of bone resorption. The authors examined whether the timing of cranioplasty after decompressive craniectomy for stroke affects postoperative complication rates. Methods. A retrospective cohort study was undertaken to evaluate complication rates in patients undergoing cranioplasty at early (within 10 weeks of craniectomy) or late (≥ 10 weeks) stages. Multivariate logistic regression analysis was used to determine characteristics that would predict complications in patients undergoing cranioplasty after decompressive craniectomy for stroke. Results. While the overall complication rate was higher in the early cranioplasty cohort (22% vs 16% in the late cranioplasty cohort), the difference was not statistically significant (p = 0.5541). Patients in the early cranioplasty cohort had lower rates of postoperative hematoma but higher rates of infection. Presence of a CSF shunt was the only significant predictor of complications (OR 8.96, 95% CI 1.84-43.6). Conclusions. Complications rates for early cranioplasty (within 10 weeks of craniectomy) are similar to those encountered when cranioplasty is delayed, although the cohort size in this study was too small to state equivalence. Patients with a ventriculoperitoneal shunt are at higher risk for complications after cranioplasty.

Original languageEnglish (US)
Pages (from-to)109-114
Number of pages6
JournalJournal of Neurosurgery
Volume118
Issue number1
DOIs
StatePublished - Jan 2013

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Decompressive Craniectomy
Stroke
Ventriculoperitoneal Shunt
Bone Resorption
Infection
Hematoma
Cohort Studies
Retrospective Studies
Logistic Models
Regression Analysis

Keywords

  • Craniectomy
  • Cranioplasty
  • Ischemic hemorrhagic stroke
  • Vascular disorders

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Timing of cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke : Clinical article. / Piedra, Mark P.; Ragel, Brian T.; Dogan, Aclan; Coppa, Nicholas D.; Delashaw, Johnny B.

In: Journal of Neurosurgery, Vol. 118, No. 1, 01.2013, p. 109-114.

Research output: Contribution to journalArticle

Piedra, Mark P. ; Ragel, Brian T. ; Dogan, Aclan ; Coppa, Nicholas D. ; Delashaw, Johnny B. / Timing of cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke : Clinical article. In: Journal of Neurosurgery. 2013 ; Vol. 118, No. 1. pp. 109-114.
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