Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders.
OBJECTIVE
This study assesses the clinical outcome after early combined cranioplasty (own frozen bone) and shunt implantation (Codman-Medos programmable VP shunt) in patients with skull bone defects and cerebrospinal fluid (CSF) circulation disorders.


METHODS
Medical records were reviewed retrospectively for the last 100 patients with CSF disorders after trauma or subarachnoid hemorrhage (SAH), who previously underwent decompressive craniotomy owing to therapy-resistant brain swelling. Patients treated with early (5 to 7 weeks after injury) combined cranioplasty and shunt implantation were analysed and a follow-up for the survivors was obtained.


RESULTS
In 60 patients with a daily CSF external drainage over 150 ml and dilated ventricles in CT scan, a programmable VP shunt was implanted simultaneously with the cranioplasty within 5.1 weeks after decompression. The neurological condition 6 months later was good (independent patients) in 39 cases (65%); 12 patients (20%) survived with a severe disability; three patients (5%) remained in a persistent vegetative state and only six patients (10%) died. There were few complications: bone or shunt infection (three cases), post-operative intracranial bleeding (one case), transitory neurological impairment after bone reimplantation (two cases), bone resorption (two cases) and shunt dysfunction (three cases).


CONCLUSIONS
The early reimplantation of the patient's own skull bone combined to the employment of a programmable shunt system allowed us a dynamic adjustment of the intracranial pressure (ICP) changes. The combined treatment reduced the number of required surgical procedures, complications and unsatisfactory patient outcomes.
Carvi Y Nievas
Mario N
MN
Department of Neurosurgery, Städtische Kliniken, Frankfurt am Main-Höchst, Germany. MCNievas@t-online.de
Höllerhage
Hans-Georg
HG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D002557:Cerebrospinal Fluid Shunts / Q000379:methods* / Q000592:standards; D003399:Craniotomy / Q000009:adverse effects*; D019299:Decompression, Surgical / Q000009:adverse effects*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D019586:Intracranial Hypertension / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D020547:Lateral Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000592:standards; D012086:Reoperation / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D012886:Skull / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D020206:Subarachnoid Hemorrhage, Traumatic / Q000150:complications / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome