Assessing the Frequency of Cranioplasty Requirements in Patients Undergoing Surgery for Depressed Skull Fractures
Keywords:
Cranioplasty, Depressed Skull Fractures, Neurological DeficitsAbstract
The study evaluated the clinical outcomes linked to the frequency of cranioplasty requirements in patients who underwent surgery for depressed skull fractures (DSF). A cross-sectional analysis was performed on 28 patients who underwent surgical intervention for DSF at DHQ Teaching Hospital Dera Ismail Khan between January 2023 and December 2023. Demographic characteristics, injury specifics, surgical details and postoperative outcomes were all collected. The primary objective was to ascertain the prevalence of cranioplasty, timing of the procedure and its influence on clinical outcomes. Cranioplasty was necessary in 7% of the patients (n=2). Both patients who required cranioplasty had dural tears and experienced postoperative complications, which included infections (100%) and cerebrospinal fluid (CSF) leakage (50%). The timeline of cranioplasty was inconsistent, with one procedure being performed during the initial surgery and the other within 1-3 months postoperatively. Although cranioplasty was efficacious in restoring cranial integrity, it was associated with a higher incidence of long-term neurological deficits (100%) than those who did not require cranioplasty. In spite of these complications, majority of the patients exhibited substantial neurological improvement and cranioplasty group's overall quality of life was only marginally decreased. Cranioplasty is thus infrequently necessary following DSF surgery, with the exception of patients who have dural injuries and substantial postoperative complications. Although it effectively restores cranial structure, it does not completely mitigate neurological deficits. The necessity of standardized protocols to optimize outcomes is underscored by the variability in the timing of cranioplasty.
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Satardey RS, Balasubramaniam S, Pandya JS, Mahey RC. Analysis of Factors Influencing Outcome of Depressed Fracture of Skull. Asian J Neurosurg. 2018 Apr-Jun;13(2):341-347. doi: 10.4103/ajns.AJNS_117_16.
Chaudhary F, Ahmed Z, Agrawal DK. Critical Assessment of the Neurological Complications during High-Risk Anesthesia Procedures. J Surg Res (Houst). 2024;7(2):250-266. Epub 2024 Jun 6.
Lenza M, Buchbinder R, Johnston RV, Ferrari BA, Faloppa F. Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Cochrane Database Syst Rev. 2019 Jan 22;1(1):CD009363. doi: 10.1002/14651858.CD009363.pub3.
Iaccarino C, Kolias AG, Roumy LG, Fountas K, Adeleye AO. Cranioplasty Following Decompressive Craniectomy. Front Neurol. 2020 Jan 29;10:1357. doi: 10.3389/fneur.2019.01357.
Mee H, Anwar F, Timofeev I, Owens N, Grieve K, Whiting G, Alexander K, Kendrick K, Helmy A, Hutchinson P, Kolias A. Cranioplasty: A Multidisciplinary Approach. Front Surg. 2022 May 17;9:864385. doi: 10.3389/fsurg.2022.864385.
Fallatah MA, Aldahlawi A, Babateen EM, Saif S, Alnejadi W, Bamsallm M, Lary A. Outcomes of Cranioplasty: A Single-Center Experience. Cureus. 2023 Feb 20;15(2):e35213. doi: 10.7759/cureus.35213.
Liao CC, Kao MC. Cranioplasty for patients with severe depressed skull bone defect after cerebrospinal fluid shunting. J Clin Neurosci. 2002 Sep;9(5):553-5. doi: 10.1054/jocn.2002.1116.
De Cola MC, Corallo F, Pria D, Lo Buono V, Calabrò RS. Timing for cranioplasty to improve neurological outcome: A systematic review. Brain Behav. 2018 Nov;8(11):e01106. doi: 10.1002/brb3.1106.
Prakash A, Harsh V, Gupta U, Kumar J, Kumar A. Depressed Fractures of Skull: An Institutional Series of 453 Patients and Brief Review of Literature. Asian J Neurosurg. 2018 Apr-Jun;13(2):222-226. doi: 10.4103/ajns.AJNS_168_16.
Tariq M, Mian MA, Filza F, Ayub S, Khan SD, Jalal K. Outcome of patients operated for depressed skull fracture (DSF) with dural tear. Pak J Neurol Surg. 2021;25(2):126-133. Available from: http://www.pakjns.org
Bonda DJ, Manjila S, Selman WR, Dean D. The Recent Revolution in the Design and Manufacture of Cranial Implants: Modern Advancements and Future Directions. Neurosurgery. 2015 Nov;77(5):814-24; discussion 824. doi: 10.1227/NEU.0000000000000899.
He L. Biomaterials for Regenerative Cranioplasty: Current State of Clinical Application and Future Challenges. J Funct Biomater. 2024 Mar 28;15(4):84. doi: 10.3390/jfb15040084.
Moellmann HL, Mehr VN, Karnatz N, Wilkat M, Riedel E, Rana M. Evaluation of the Fitting Accuracy of CAD/CAM-Manufactured Patient-Specific Implants for the Reconstruction of Cranial Defects-A Retrospective Study. J Clin Med. 2022 Apr 6;11(7):2045. doi: 10.3390/jcm11072045.
Gooch MR, Gin GE, Kenning TJ, German JW. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus. 2009 Jun;26(6):E9. doi: 10.3171/2009.3.FOCUS0962.
Aloraidi A, Alkhaibary A, Alharbi A, Alnefaie N, Alaglan A, AlQarni A, Elarjani T, Arab A, Abdullah JM, Almubarak AO, Abbas M, Khairy I, Almadani WH, Alowhaibi M, Alarifi A, Khairy S, Alkhani A. Effect of cranioplasty timing on the functional neurological outcome and postoperative complications. Surg Neurol Int. 2021 Jun 7;12:264. doi: 10.25259/SNI_802_2020.
Nam HH, Ki HJ, Lee HJ, Park SK. Complications of Cranioplasty Following Decompressive Craniectomy: Risk Factors of Complications and Comparison Between Autogenous and Artificial Bones. Korean J Neurotrauma. 2022 Sep 1;18(2):238-245. doi: 10.13004/kjnt.2022.18.e40.
Jeong SH, Wang US, Kim SW, Ha SW, Kim JK. Symptomatic Epidural Fluid Collection Following Cranioplasty after Decompressive Craniectomy for Traumatic Brain Injury. Korean J Neurotrauma. 2016 Apr;12(1):6-10. doi: 10.13004/kjnt.2016.12.1.6.
Singh S, Singh R, Jain K, Walia B. Cranioplasty following decompressive craniectomy - Analysis of complication rates and neurological outcomes: A single center study. Surg Neurol Int. 2019 Jul 19;10:142. doi: 10.25259/SNI_29_2019.
Mele C, Bassetto A, Boetto V, Nardone A, Pingue V. Impact of Cranioplasty on Rehabilitation Course of Patients with Traumatic or Hemorrhagic Brain Injury. Brain Sciences. 2023; 13(1):80. https://doi.org/10.3390/brainsci13010080
Kim MJ, Lee HB, Ha SK, Lim DJ, Kim SD. Predictive Factors of Surgical Site Infection Following Cranioplasty: A Study Including 3D Printed Implants. Front Neurol. 2021 Nov 2;12:745575. doi: 10.3389/fneur.2021.745575.
Shepetovsky D, Mezzini G, Magrassi L. Complications of cranioplasty in relationship to traumatic brain injury: a systematic review and meta-analysis. Neurosurg Rev. 2021 Dec;44(6):3125-3142. doi: 10.1007/s10143-021-01511-7.
Morgan RD, Kharbat AF, Collins RA, Garza J, Belirgen M, Nagy L. Analysis of the timing and the usage of drains following cranioplasty on outcomes and the incidence of bone resorption. Surg Neurol Int. 2023 Sep 15;14:329. doi: 10.25259/SNI_471_2023.
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