University of Oulu

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.

Cranioplasty after severe traumatic brain injury : effects of trauma and patient recovery on cranioplasty outcome

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Author: Posti, Jussi P.1,2,3,4; Yli-Olli, Matias1,2,3,4; Heiskanen, Lauri1,2,3;
Organizations: 1Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland
2Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland
3Department of Neurology, University of Turku, Turku, Finland
4Department of Biomaterials Science and Turku Clinical Biomaterials Centre––TCBC, Institute of Dentistry, University of Turku, Turku, Finland
5Department of Otorhinolaryngology––Head and Neck Surgery, Division of Surgery and Cancer Diseases, Turku University Hospital, Turku, Finland
6Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
7MRC Oulu, PEDEGO Research Center, Oulu University, Oulu, Finland
8City of Turku Welfare Division, Turku, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
Persistent link:
Language: English
Published: Frontiers Media, 2018
Publish Date: 2019-10-02


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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Series: Frontiers in neurology
ISSN: 1664-2295
ISSN-E: 1664-2295
ISSN-L: 1664-2295
Volume: 9
Article number: 223
DOI: 10.3389/fneur.2018.00223
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Funding: JPP is financially supported by Government’s Special Financial Transfer tied to academic research in Health Sciences (Finland), Emil Aaltonen Foundation, and Finnish Brain Foundation.
Copyright information: © 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.