title: Timing of cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke.
abstract: OBJECTIVE
  The optimal timing of cranioplasty after decompressive craniectomy for stroke is not known. Case series suggest that early cranioplasty is associated with higher rates of infection while delaying cranioplasty may be associated with higher rates of bone resorption. The authors examined whether the timing of cranioplasty after decompressive craniectomy for stroke affects postoperative complication rates.
  
  
  METHODS
  A retrospective cohort study was undertaken to evaluate complication rates in patients undergoing cranioplasty at early (within 10 weeks of craniectomy) or late (≥ 10 weeks) stages. Multivariate logistic regression analysis was used to determine characteristics that would predict complications in patients undergoing cranioplasty after decompressive craniectomy for stroke.
  
  
  RESULTS
  While the overall complication rate was higher in the early cranioplasty cohort (22% vs 16% in the late cranioplasty cohort), the difference was not statistically significant (p = 0.5541). Patients in the early cranioplasty cohort had lower rates of postoperative hematoma but higher rates of infection. Presence of a CSF shunt was the only significant predictor of complications (OR 8.96, 95% CI 1.84-43.6).
  
  
  CONCLUSIONS
  Complications rates for early cranioplasty (within 10 weeks of craniectomy) are similar to those encountered when cranioplasty is delayed, although the cohort size in this study was too small to state equivalence. Patients with a ventriculoperitoneal shunt are at higher risk for complications after cranioplasty.
authors.affiliation: Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Piedra
authors.forename: Brian T
authors.initials: BT
authors.lastname: Ragel
authors.forename: Aclan
authors.initials: A
authors.lastname: Dogan
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Coppa
authors.forename: Johnny B
authors.initials: JB
authors.lastname: Delashaw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D020521:Stroke / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome