A1 Refereed original research article in a scientific journal
Cranioplasty After Severe Traumatic Brain Injury: Effects of Trauma and Patient Recovery on Cranioplasty Outcome
Authors: Jussi P. Posti, Matias Yli-Olli, Lauri Heiskanen, Kalle M. J. Aitasalo, Jaakko Rinne, Ville Vuorinen, Willy Serlo, Olli Tenovuo, Pekka K. Vallittu, Jaakko M. Piitulainen
Publisher: FRONTIERS MEDIA SA
Publication year: 2018
Journal: Frontiers in Neurology
Journal name in source: FRONTIERS IN NEUROLOGY
Journal acronym: FRONT NEUROL
Article number: ARTN 223
Volume: 9
Number of pages: 7
ISSN: 1664-2295
DOI: https://doi.org/10.3389/fneur.2018.00223
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/29618439
Background: In patients with severe traumatic brain injury (sTBI) treated with decompressive craniectomy (DC), factors affecting the success of later cranioplasty are poorly known.Objective: 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: A retrospective cohort of 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 1 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 1 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 intensive care unit, cranioplasty materials, and timing of cranioplasty were not associated with major complications.Conclusion: A successful cranioplasty after sTBI and DC predicts favorable outcome 1 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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