Cranioplasty after severe traumatic brain injury : effects of trauma and patient recovery on cranioplasty outcome
Posti, Jussi P.; Yli-Olli, Matias; Heiskanen, Lauri; Aitasalo, Kalle M. J.; Rinne, Jaakko; Vuorinen, Ville; Serlo, Willy; Tenovuo, Olli; Vallittu, Pekka K.; Piitulainen, Jaakko M. (2018-04-09)
Posti, J. P., Yli-Olli, M., Heiskanen, L., Aitasalo, K. M. J., Rinne, J., Vuorinen, V., … Piitulainen, J. M. (2018). Cranioplasty After Severe Traumatic Brain Injury: Effects of Trauma and Patient Recovery on Cranioplasty Outcome. Frontiers in Neurology, 9. https://doi.org/10.3389/fneur.2018.00223
© 2018 Posti, Yli-Olli, Heiskanen, Aitasalo, Rinne, Vuorinen, Serlo, Tenovuo, Vallittu and Piitulainen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
https://creativecommons.org/licenses/by/4.0/
https://urn.fi/URN:NBN:fi-fe2019100230811
Tiivistelmä
Abstract
Background: In patients with severe traumatic brain injury (sTBI) treated with decompressive craniectomy (DC), factors affecting the success of later cranioplasty are poorly known.
Objective: We sought to investigate if injury- and treatment-related factors, and state of recovery could predict the risk of major complications in cranioplasty requiring implant removal, and how these complications affect the outcome.
Methods: A retrospective cohort of 40 patients with DC following sTBI and subsequent cranioplasty was studied. Non-injury-related factors were compared with a reference population of 115 patients with DC due to other conditions.
Results: Outcome assessed 1 day before cranioplasty did not predict major complications leading to implant removal. Successful cranioplasty was associated with better outcome, whereas a major complication attenuates patient recovery: in patients with favorable outcome assessed 1 year after cranioplasty, major complication rate was 7%, while in patients with unfavorable outcome the rate was 42% (p = 0.003). Of patients with traumatic subarachnoid hemorrhage (tSAH) on admission imaging 30% developed a major complication, while none of patients without tSAH had a major complication (p = 0.014). Other imaging findings, age, admission Glasgow Coma Scale, extracranial injuries, length of stay at intensive care unit, cranioplasty materials, and timing of cranioplasty were not associated with major complications.
Conclusion: A successful cranioplasty after sTBI and DC predicts favorable outcome 1 year after cranioplasty, while stage of recovery before cranioplasty does not predict cranioplasty success or failure. tSAH on admission imaging is a major risk factor for a major complication leading to implant removal.
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