Boon Leong Quah1, Hu Liang Low2, Mark H Wilson3, Alexios Bimpis3, Vincent D W Nga4, Sein Lwin4, Noor Hazlina Zainuddin5, Nasser Abd Wahab5, Md Al Amin Salek6. 1. Essex Neuroscience Centre, Department of Neurosurgery, Queen's Hospital, Romford, Essex, United Kingdom; Division of Neurosurgery, Department of General Surgery, Khoo Teck Puat Hospital, Singapore. Electronic address: drquah@gmail.com. 2. Essex Neuroscience Centre, Department of Neurosurgery, Queen's Hospital, Romford, Essex, United Kingdom. 3. Department of Neurosurgery, St. Mary's Hospital, Imperial College NHS Trust, London, United Kingdom. 4. Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore. 5. Department of Neurosurgery, Hospital Pulau Pinang, Pulau Pinang, Malaysia. 6. Department of Neurosurgery, United Hospital Limited, Dhaka, Bangladesh.
Abstract
BACKGROUND: The optimal timing of cranioplasty remains uncertain. OBJECTIVE: We hypothesized that the risk of infections after primary cranioplasty in adult patients who underwent craniectomies for non-infection-related indications are no different when performed early or delayed. We tested this hypothesis in a prospective, multicenter, cohort study. METHODS: Data were collected prospectively from 5 neurosurgical centers in the United Kingdom, Malaysia, Singapore, and Bangladesh. Only patients older than 16 years from the time of the non-infection-related craniectomy were included. The recruitment period was over 17 months, and postoperative follow-up was at least 6 months. Patient baseline characteristics, rate of infections, and incidence of hydrocephalus were collected. RESULTS: Seventy patients were included in this study. There were 25 patients in the early cranioplasty cohort (cranioplasty performed before 12 weeks) and 45 patients in the late cranioplasty cohort (cranioplasty performed after 12 weeks). The follow-up period ranged between 16 and 34 months (mean, 23 months). Baseline characteristics were largely similar but differed only in prophylactic antibiotics received (P = 0.28), and primary surgeon performing cranioplasty (P = 0.15). There were no infections in the early cranioplasty cohort, whereas 3 infections were recorded in the late cohort. This did not reach statistical significance (P = 0.55). CONCLUSIONS: Early cranioplasty in non-infection-related craniectomy is relatively safe. There does not appear to be an added advantage to delaying cranioplasties more than 12 weeks after the initial craniectomy in terms of infection reduction. There was no significant difference in infection rates or risk of hydrocephalus between the early and late cohorts.
BACKGROUND: The optimal timing of cranioplasty remains uncertain. OBJECTIVE: We hypothesized that the risk of infections after primary cranioplasty in adult patients who underwent craniectomies for non-infection-related indications are no different when performed early or delayed. We tested this hypothesis in a prospective, multicenter, cohort study. METHODS: Data were collected prospectively from 5 neurosurgical centers in the United Kingdom, Malaysia, Singapore, and Bangladesh. Only patients older than 16 years from the time of the non-infection-related craniectomy were included. The recruitment period was over 17 months, and postoperative follow-up was at least 6 months. Patient baseline characteristics, rate of infections, and incidence of hydrocephalus were collected. RESULTS: Seventy patients were included in this study. There were 25 patients in the early cranioplasty cohort (cranioplasty performed before 12 weeks) and 45 patients in the late cranioplasty cohort (cranioplasty performed after 12 weeks). The follow-up period ranged between 16 and 34 months (mean, 23 months). Baseline characteristics were largely similar but differed only in prophylactic antibiotics received (P = 0.28), and primary surgeon performing cranioplasty (P = 0.15). There were no infections in the early cranioplasty cohort, whereas 3 infections were recorded in the late cohort. This did not reach statistical significance (P = 0.55). CONCLUSIONS: Early cranioplasty in non-infection-related craniectomy is relatively safe. There does not appear to be an added advantage to delaying cranioplasties more than 12 weeks after the initial craniectomy in terms of infection reduction. There was no significant difference in infection rates or risk of hydrocephalus between the early and late cohorts.
Authors: Maria C De Cola; Francesco Corallo; Deborah Pria; Viviana Lo Buono; Rocco S Calabrò Journal: Brain Behav Date: 2018-10-02 Impact factor: 2.708