title: Comparative Study of Outcomes between Shunting after Cranioplasty and in Cranioplasty after Shunting in Large Concave Flaccid Cranial Defect with Hydrocephalus.
abstract: OBJECTIVE
  The cranioplasty and ventriculoperitoneal (VP) shunt operation have been used to treat a large cranial defect with posttraumatic hydrocephalus (PTH). The aim of this study was to evlauate the difference of outcomes between in the shunting after the cranioplasty (group 1) and the cranioplasty after the shunting (group 2) in a large flaccid cranial defect with PTH.
  
  
  METHODS
  In this study, a retrospective review was done on 23 patients undergoing the cranioplasty and VP shunt operation after the decompressive craniectomy for a refractory intracranial hypertension from 2002 to 2005. All of 23 cases had a large flaccid concave cranial defect and PTH. Ten cases belong to group 1 and 13 cases to group 2. The outcomes after operations were compared in two groups 6 months later.
  
  
  RESULTS
  The improvement of Glasgow outcome scale (GOS) was seen in 8 cases (80.0%) of total 10 cases in group 1, and 6 cases (46.2%) of 13 cases in group 2. Three (75.0%) of 4 cases with hemiparesis in group 1 and 3 of 6 cases (50.0%) in group 2 were improved. All cases (2 cases) with decrease of visual acuity were improved in each group. Dysphasia was improved in 3 of 5 cases (60%) in group 1 and 4 of 6 cases (66.6%) in group 2.
  
  
  CONCLUSIONS
  These results suggest that outcomes in group 1 may be better than in group 2 for a large flaccid concave cranial defect with PTH.
authors.affiliation: Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea.
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Oh
authors.forename: Chong Oon
authors.initials: CO
authors.lastname: Park
authors.forename: Dong Keun
authors.initials: DK
authors.lastname: Hyun
authors.forename: Hyung Chun
authors.initials: HC
authors.lastname: Park
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Yoon