Complications in cranioplasty after decompressive craniectomy: timing of the intervention
Objective To prevent complications following decompressive craniectomy (DC), such as sinking skin flap syndrome, studies suggested early cranioplasty (CP). However, several groups reported higher complication rates in early CP. We studied the clinical characteristics associated with complications in...
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| Veröffentlicht in: | Journal of neurology 2020-05, Vol.267 (5), p.1312-1320 |
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| creator | Goedemans, Taco Verbaan, Dagmar van der Veer, Olivier Bot, Maarten Post, René Hoogmoed, Jantien Lequin, Michiel B. Buis, Dennis R. Vandertop, W. Peter Coert, Bert A. van den Munckhof, Pepijn |
| description | Objective
To prevent complications following decompressive craniectomy (DC), such as sinking skin flap syndrome, studies suggested early cranioplasty (CP). However, several groups reported higher complication rates in early CP. We studied the clinical characteristics associated with complications in patients undergoing CP, with special emphasis on timing.
Methods
A single-center observational cohort study was performed, including all patients undergoing CP from 2006 to 2018, to identify predictors of complications.
Results
145 patients underwent CP: complications occurred in 33 (23%): 18 (12%) epi/subdural hemorrhage, 10 (7%) bone flap infection, 4 (3%) hygroma requiring drainage, and 1 (1%) post-CP hydrocephalus. On univariate analysis, acute subdural hematoma as etiology of DC, symptomatic cerebrospinal fluid (CSF) flow disturbance (hydrocephalus) prior to CP, and CP within three months after DC were associated with higher complication rates. On multivariate analysis, only acute subdural hematoma as etiology of DC (OR 7.5; 95% CI 1.9–29.5) and symptomatic CSF flow disturbance prior to CP (OR 2.9; 95% CI 1.1–7.9) were associated with higher complication rates. CP performed within three months after DC was not (OR 1.4; 95% CI 0.5–3.9). Pre-CP symptomatic CSF flow disturbance was the only variable associated with the occurrence of epi/subdural hemorrhage. (OR 3.8; 95% CI 1.6–9.0)
Conclusion
Cranioplasty has high complication rates, 23% in our cohort. Contrary to recent systematic reviews, early CP was associated with more complications (41%), explained by the higher incidence of pre-CP CSF flow disturbance and acute subdural hematoma as etiology of DC. CP in such patients should therefore be performed with highest caution. |
| doi_str_mv | 10.1007/s00415-020-09695-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7184041</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2394757420</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-9d851621b5f7994104fa65f8e27424db7e674844325fc2c4e387b857df20e58b3</originalsourceid><addsrcrecordid>eNp9kTtvFDEUhS0EIpvAH6BAI9HQDFy_PRRIaAUBKRINFFSWx3Nn42jGXuzZlfbf4zAhPAoqF-c7597rQ8gzCq8ogH5dAASVLTBooVOdbNUDsqGCs5YK2T0kG-ACWsmlOCPnpdwAgKnCY3LGaSe5ArUh37Zp3k_BuyWkWJoQG59dDGk_ubKcGjcumJsBfaUylhKOuALolzSf3jRLmEPcNWlslmus9oofMd6GPSGPRjcVfHr3XpCvH95_2X5srz5fftq-u2q90GJpu8FIqhjt5ai7TlAQo1NyNMi0YGLoNSotjKhXydEzL5Ab3Ruph5EBStPzC_J2zd0f-hkHX6dnN9l9DrPLJ5tcsH8rMVzbXTpaTY2oH1gDXt4F5PT9gGWxcygep8lFTIdiGRdUgQYjK_riH_QmHXKs51WqE1rWnaFSbKV8TqVkHO-XoWBvm7Nrc7Y2Z382Z1U1Pf_zjHvLr6oqwFegVCnuMP-e_Z_YHw5NpT4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2394757420</pqid></control><display><type>article</type><title>Complications in cranioplasty after decompressive craniectomy: timing of the intervention</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Goedemans, Taco ; Verbaan, Dagmar ; van der Veer, Olivier ; Bot, Maarten ; Post, René ; Hoogmoed, Jantien ; Lequin, Michiel B. ; Buis, Dennis R. ; Vandertop, W. Peter ; Coert, Bert A. ; van den Munckhof, Pepijn</creator><creatorcontrib>Goedemans, Taco ; Verbaan, Dagmar ; van der Veer, Olivier ; Bot, Maarten ; Post, René ; Hoogmoed, Jantien ; Lequin, Michiel B. ; Buis, Dennis R. ; Vandertop, W. Peter ; Coert, Bert A. ; van den Munckhof, Pepijn</creatorcontrib><description>Objective
To prevent complications following decompressive craniectomy (DC), such as sinking skin flap syndrome, studies suggested early cranioplasty (CP). However, several groups reported higher complication rates in early CP. We studied the clinical characteristics associated with complications in patients undergoing CP, with special emphasis on timing.
Methods
A single-center observational cohort study was performed, including all patients undergoing CP from 2006 to 2018, to identify predictors of complications.
Results
145 patients underwent CP: complications occurred in 33 (23%): 18 (12%) epi/subdural hemorrhage, 10 (7%) bone flap infection, 4 (3%) hygroma requiring drainage, and 1 (1%) post-CP hydrocephalus. On univariate analysis, acute subdural hematoma as etiology of DC, symptomatic cerebrospinal fluid (CSF) flow disturbance (hydrocephalus) prior to CP, and CP within three months after DC were associated with higher complication rates. On multivariate analysis, only acute subdural hematoma as etiology of DC (OR 7.5; 95% CI 1.9–29.5) and symptomatic CSF flow disturbance prior to CP (OR 2.9; 95% CI 1.1–7.9) were associated with higher complication rates. CP performed within three months after DC was not (OR 1.4; 95% CI 0.5–3.9). Pre-CP symptomatic CSF flow disturbance was the only variable associated with the occurrence of epi/subdural hemorrhage. (OR 3.8; 95% CI 1.6–9.0)
Conclusion
Cranioplasty has high complication rates, 23% in our cohort. Contrary to recent systematic reviews, early CP was associated with more complications (41%), explained by the higher incidence of pre-CP CSF flow disturbance and acute subdural hematoma as etiology of DC. CP in such patients should therefore be performed with highest caution.</description><identifier>ISSN: 0340-5354</identifier><identifier>EISSN: 1432-1459</identifier><identifier>DOI: 10.1007/s00415-020-09695-6</identifier><identifier>PMID: 31953606</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Blood ; Brain ; Cerebrospinal fluid ; Decompressive Craniectomy - statistics & numerical data ; Dura mater ; Etiology ; Female ; Fluid flow ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Male ; Medicine ; Medicine & Public Health ; Meninges ; Middle Aged ; Multivariate analysis ; Neurology ; Neuroradiology ; Neurosciences ; Neurosurgery ; Original Communication ; Postoperative Complications - epidemiology ; Reconstructive Surgical Procedures - adverse effects ; Reconstructive Surgical Procedures - statistics & numerical data ; Retrospective Studies ; Skull ; Skull - surgery</subject><ispartof>Journal of neurology, 2020-05, Vol.267 (5), p.1312-1320</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-9d851621b5f7994104fa65f8e27424db7e674844325fc2c4e387b857df20e58b3</citedby><cites>FETCH-LOGICAL-c474t-9d851621b5f7994104fa65f8e27424db7e674844325fc2c4e387b857df20e58b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00415-020-09695-6$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00415-020-09695-6$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31953606$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goedemans, Taco</creatorcontrib><creatorcontrib>Verbaan, Dagmar</creatorcontrib><creatorcontrib>van der Veer, Olivier</creatorcontrib><creatorcontrib>Bot, Maarten</creatorcontrib><creatorcontrib>Post, René</creatorcontrib><creatorcontrib>Hoogmoed, Jantien</creatorcontrib><creatorcontrib>Lequin, Michiel B.</creatorcontrib><creatorcontrib>Buis, Dennis R.</creatorcontrib><creatorcontrib>Vandertop, W. Peter</creatorcontrib><creatorcontrib>Coert, Bert A.</creatorcontrib><creatorcontrib>van den Munckhof, Pepijn</creatorcontrib><title>Complications in cranioplasty after decompressive craniectomy: timing of the intervention</title><title>Journal of neurology</title><addtitle>J Neurol</addtitle><addtitle>J Neurol</addtitle><description>Objective
To prevent complications following decompressive craniectomy (DC), such as sinking skin flap syndrome, studies suggested early cranioplasty (CP). However, several groups reported higher complication rates in early CP. We studied the clinical characteristics associated with complications in patients undergoing CP, with special emphasis on timing.
Methods
A single-center observational cohort study was performed, including all patients undergoing CP from 2006 to 2018, to identify predictors of complications.
Results
145 patients underwent CP: complications occurred in 33 (23%): 18 (12%) epi/subdural hemorrhage, 10 (7%) bone flap infection, 4 (3%) hygroma requiring drainage, and 1 (1%) post-CP hydrocephalus. On univariate analysis, acute subdural hematoma as etiology of DC, symptomatic cerebrospinal fluid (CSF) flow disturbance (hydrocephalus) prior to CP, and CP within three months after DC were associated with higher complication rates. On multivariate analysis, only acute subdural hematoma as etiology of DC (OR 7.5; 95% CI 1.9–29.5) and symptomatic CSF flow disturbance prior to CP (OR 2.9; 95% CI 1.1–7.9) were associated with higher complication rates. CP performed within three months after DC was not (OR 1.4; 95% CI 0.5–3.9). Pre-CP symptomatic CSF flow disturbance was the only variable associated with the occurrence of epi/subdural hemorrhage. (OR 3.8; 95% CI 1.6–9.0)
Conclusion
Cranioplasty has high complication rates, 23% in our cohort. Contrary to recent systematic reviews, early CP was associated with more complications (41%), explained by the higher incidence of pre-CP CSF flow disturbance and acute subdural hematoma as etiology of DC. CP in such patients should therefore be performed with highest caution.</description><subject>Adult</subject><subject>Blood</subject><subject>Brain</subject><subject>Cerebrospinal fluid</subject><subject>Decompressive Craniectomy - statistics & numerical data</subject><subject>Dura mater</subject><subject>Etiology</subject><subject>Female</subject><subject>Fluid flow</subject><subject>Hematoma</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Hydrocephalus</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meninges</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Original Communication</subject><subject>Postoperative Complications - epidemiology</subject><subject>Reconstructive Surgical Procedures - adverse effects</subject><subject>Reconstructive Surgical Procedures - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Skull</subject><subject>Skull - surgery</subject><issn>0340-5354</issn><issn>1432-1459</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kTtvFDEUhS0EIpvAH6BAI9HQDFy_PRRIaAUBKRINFFSWx3Nn42jGXuzZlfbf4zAhPAoqF-c7597rQ8gzCq8ogH5dAASVLTBooVOdbNUDsqGCs5YK2T0kG-ACWsmlOCPnpdwAgKnCY3LGaSe5ArUh37Zp3k_BuyWkWJoQG59dDGk_ubKcGjcumJsBfaUylhKOuALolzSf3jRLmEPcNWlslmus9oofMd6GPSGPRjcVfHr3XpCvH95_2X5srz5fftq-u2q90GJpu8FIqhjt5ai7TlAQo1NyNMi0YGLoNSotjKhXydEzL5Ab3Ruph5EBStPzC_J2zd0f-hkHX6dnN9l9DrPLJ5tcsH8rMVzbXTpaTY2oH1gDXt4F5PT9gGWxcygep8lFTIdiGRdUgQYjK_riH_QmHXKs51WqE1rWnaFSbKV8TqVkHO-XoWBvm7Nrc7Y2Z382Z1U1Pf_zjHvLr6oqwFegVCnuMP-e_Z_YHw5NpT4</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Goedemans, Taco</creator><creator>Verbaan, Dagmar</creator><creator>van der Veer, Olivier</creator><creator>Bot, Maarten</creator><creator>Post, René</creator><creator>Hoogmoed, Jantien</creator><creator>Lequin, Michiel B.</creator><creator>Buis, Dennis R.</creator><creator>Vandertop, W. Peter</creator><creator>Coert, Bert A.</creator><creator>van den Munckhof, Pepijn</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200501</creationdate><title>Complications in cranioplasty after decompressive craniectomy: timing of the intervention</title><author>Goedemans, Taco ; Verbaan, Dagmar ; van der Veer, Olivier ; Bot, Maarten ; Post, René ; Hoogmoed, Jantien ; Lequin, Michiel B. ; Buis, Dennis R. ; Vandertop, W. Peter ; Coert, Bert A. ; van den Munckhof, Pepijn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-9d851621b5f7994104fa65f8e27424db7e674844325fc2c4e387b857df20e58b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Blood</topic><topic>Brain</topic><topic>Cerebrospinal fluid</topic><topic>Decompressive Craniectomy - statistics & numerical data</topic><topic>Dura mater</topic><topic>Etiology</topic><topic>Female</topic><topic>Fluid flow</topic><topic>Hematoma</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Hydrocephalus</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meninges</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Neurosurgery</topic><topic>Original Communication</topic><topic>Postoperative Complications - epidemiology</topic><topic>Reconstructive Surgical Procedures - adverse effects</topic><topic>Reconstructive Surgical Procedures - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Skull</topic><topic>Skull - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goedemans, Taco</creatorcontrib><creatorcontrib>Verbaan, Dagmar</creatorcontrib><creatorcontrib>van der Veer, Olivier</creatorcontrib><creatorcontrib>Bot, Maarten</creatorcontrib><creatorcontrib>Post, René</creatorcontrib><creatorcontrib>Hoogmoed, Jantien</creatorcontrib><creatorcontrib>Lequin, Michiel B.</creatorcontrib><creatorcontrib>Buis, Dennis R.</creatorcontrib><creatorcontrib>Vandertop, W. Peter</creatorcontrib><creatorcontrib>Coert, Bert A.</creatorcontrib><creatorcontrib>van den Munckhof, Pepijn</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goedemans, Taco</au><au>Verbaan, Dagmar</au><au>van der Veer, Olivier</au><au>Bot, Maarten</au><au>Post, René</au><au>Hoogmoed, Jantien</au><au>Lequin, Michiel B.</au><au>Buis, Dennis R.</au><au>Vandertop, W. Peter</au><au>Coert, Bert A.</au><au>van den Munckhof, Pepijn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complications in cranioplasty after decompressive craniectomy: timing of the intervention</atitle><jtitle>Journal of neurology</jtitle><stitle>J Neurol</stitle><addtitle>J Neurol</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>267</volume><issue>5</issue><spage>1312</spage><epage>1320</epage><pages>1312-1320</pages><issn>0340-5354</issn><eissn>1432-1459</eissn><abstract>Objective
To prevent complications following decompressive craniectomy (DC), such as sinking skin flap syndrome, studies suggested early cranioplasty (CP). However, several groups reported higher complication rates in early CP. We studied the clinical characteristics associated with complications in patients undergoing CP, with special emphasis on timing.
Methods
A single-center observational cohort study was performed, including all patients undergoing CP from 2006 to 2018, to identify predictors of complications.
Results
145 patients underwent CP: complications occurred in 33 (23%): 18 (12%) epi/subdural hemorrhage, 10 (7%) bone flap infection, 4 (3%) hygroma requiring drainage, and 1 (1%) post-CP hydrocephalus. On univariate analysis, acute subdural hematoma as etiology of DC, symptomatic cerebrospinal fluid (CSF) flow disturbance (hydrocephalus) prior to CP, and CP within three months after DC were associated with higher complication rates. On multivariate analysis, only acute subdural hematoma as etiology of DC (OR 7.5; 95% CI 1.9–29.5) and symptomatic CSF flow disturbance prior to CP (OR 2.9; 95% CI 1.1–7.9) were associated with higher complication rates. CP performed within three months after DC was not (OR 1.4; 95% CI 0.5–3.9). Pre-CP symptomatic CSF flow disturbance was the only variable associated with the occurrence of epi/subdural hemorrhage. (OR 3.8; 95% CI 1.6–9.0)
Conclusion
Cranioplasty has high complication rates, 23% in our cohort. Contrary to recent systematic reviews, early CP was associated with more complications (41%), explained by the higher incidence of pre-CP CSF flow disturbance and acute subdural hematoma as etiology of DC. CP in such patients should therefore be performed with highest caution.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31953606</pmid><doi>10.1007/s00415-020-09695-6</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of neurology, 2020-05, Vol.267 (5), p.1312-1320 |
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| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Blood Brain Cerebrospinal fluid Decompressive Craniectomy - statistics & numerical data Dura mater Etiology Female Fluid flow Hematoma Hemorrhage Humans Hydrocephalus Male Medicine Medicine & Public Health Meninges Middle Aged Multivariate analysis Neurology Neuroradiology Neurosciences Neurosurgery Original Communication Postoperative Complications - epidemiology Reconstructive Surgical Procedures - adverse effects Reconstructive Surgical Procedures - statistics & numerical data Retrospective Studies Skull Skull - surgery |
| title | Complications in cranioplasty after decompressive craniectomy: timing of the intervention |
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