Introduction: Randomized trials have shown that decompressive craniectomy to treat malignant cerebral edema after stroke increases survival. The appropriate timing of cranioplasty after craniectomy for stroke is not known. We aimed to determine the effect of early cranioplasty (within 10 weeks) on the rate of complications.
Methods: Between 2001 and 2010 we identified 74 patients that underwent cranioplasty after decompressive craniectomy for malignant cerebral edema from ischemic or hemorrhagic stroke. Patients were separated into early (within 10 weeks of craniectomy) and late cohorts. We compared rates of infection, hydrocephalus, epidural hematoma, and bone resorption between the two cohorts.
Results: There were 37 early and 37 late cranioplasty patients. There were no significant differences in age, sex, reason for decompression (ischemic or hemorrhage stroke), presence of VP shunt, or use of surgical drains between the cohorts.
Complication rates between the early and late cohorts showed no significant difference (21.6% early; 16.2% late, p=0.5930. The early cohort had higher rates of infection (13.5% early; 8.1% late, p=1) and the late cohort had higher rates of epidural hematoma (2.7% early; 5.4% late, p=0.7106), though neither difference was statistically significant. The rates of hydrocephalus and bone graft resorption were similar between the cohorts.
Logistic regression analysis to identify predictors of complications revealed a higher risk in patients undergoing cranioplasty in the presence of a VP shunt (OR 8.96, 95% CI 1.84 – 43.6, p=0.0067). Age, time to cranioplasty, sex, type of cranioplasty (autologous vs. synthetic), and use of surgical drains were not predictive of complications.
Conclusions: There is a trend toward higher complication rates, including infection, in performing cranioplasty within 10 weeks of craniectomy for stroke. Patients with VP shunts are at increased risk for post-cranioplasty complications.
Patient Care: Understanding how timing of cranioplasty can be a factor in controlling rates of complications.
Learning Objectives: By conclusion of this session participants should be able to understand the rates of complications of cranioplasty after craniectomy for ischemic or hemorrhagic stroke based on time to cranioplasty.