Decompressive craniectomy for stroke: early cranioplasty is a predictor for postoperative complications

Abstract Background Previous clinical studies assumed early cranioplasty (CP) mandatory for a favorable neurological recovery after decompressive craniectomy (DC) due to malignant stroke. However, the appropriate timing of the CP procedure after DC remains controversial. The scope of this study was to assess patients who underwent DC due to cerebral ischemia with regard to appropriate timepoint of CP and surgical-associated complications. Methods Data were retrospectively evaluated between 2007 and 2014, CP was performed in 75 patients who previously underwent DC due to supratentorial cerebral infarction. Patients were divided into two groups (early CP vs. late CP) according to the time from DC to CP (< 3 months vs. ≥ 3 months). Patient characteristics, timing of CP, and CP associated postoperative complications were analyzed. Results Overall, CP was performed early in 12 (16%), and late in 63 patients (84%). Overall complication rate after CP was 18% including wound healing disturbance in 8 patients (11%), EDH or SDH in 4 patients (4%) and others in 2 patients (3%). Patients with early CP suffered significantly more often from complications compared to patients with late CP after initial DC (5 out of 12 patients [42%] vs. 8 out of 63 patients [13%]; p=0.02). In the multivariate analysis, early CP was a significant predictor of postoperative complications after CP (p=0.01; OR 6.04; 95% CI 1.4-24.9). Conclusions The present data suggests that patients who underwent DC for stroke might benefit from CP performed more than 3 months after DC due to a lower rate of wound infection.d