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Cranioplasty after severe traumatic brain injury: effects of trauma and patient recovery on cranioplasty outcome
Author(s): ,
J.P. Posti
Affiliations:
Turku University Hospital, Department of Neurosurgery, Turku, Finland; Turku University Hospital, Turku Brain Injury Centre, Turku, Finland; University of Turku, Department of Neurology, Turku, Finland
,
M. Yli-Olli
Affiliations:
Turku University Hospital, Department of Neurosurgery, Turku, Finland; Turku University Hospital, Turku Brain Injury Centre, Turku, Finland; University of Turku, Department of Neurology, Turku, Finland
,
L. Heiskanen
Affiliations:
Turku University Hospital, Department of Neurosurgery, Turku, Finland; Turku University Hospital, Turku Brain Injury Centre, Turku, Finland; University of Turku, Department of Neurology, Turku, Finland
,
K.M.J. Aitasalo
Affiliations:
Turku University Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Turku, Finland; University of Turku, Department of Biomaterials Science and Turku Clinical Biomaterials Centre - TCBC, Institute of Dentistry, Turku, Finland
,
J. Rinne
Affiliations:
Turku University Hospital, Department of Neurosurgery, Turku, Finland; University of Turku, Department of Neurology, Turku, Finland
,
V. Vuorinen
Affiliations:
Turku University Hospital, Department of Neurosurgery, Turku, Finland
,
W. Serlo
Affiliations:
Oulu University Hospital, Department of Children and Adolescents, Oulu, Finland; University of Oulu, MRC Oulu and PEDEGO research center, Oulu, Finland
,
O. Tenovuo
Affiliations:
Turku University Hospital, Turku Brain Injury Centre, Turku, Finland; University of Turku, Department of Neurology, Turku, Finland
,
P.K. Vallittu
Affiliations:
City of Turku, Welfare Division, Turku, Finland; University of Turku, Turku Centre for Biotechnology, Turku, Finland
J.M. Piitulainen
Affiliations:
Turku University Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Turku, Finland; University of Turku, Turku Centre for Biotechnology, Turku, Finland
EANS Academy. Posti J. Oct 21, 2018; 225742; EP5063
Assoc. Prof. Jussi P. Posti
Assoc. Prof. Jussi P. Posti
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Abstract
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Background: In patients with severe traumatic brain injury (sTBI) treated with decompressive craniectomy (DC), factors affecting the success of later cranioplasty are poorly known. 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: In a restrospective consecutive series of 155 cases, 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 one 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 one 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 ICU, cranioplasty materials, and timing of cranioplasty were not associated with major complications.

Conclusion: A successful cranioplasty after sTBI and DC predicts favorable outcome one 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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