title: Early cranioplasty may improve outcome in neurological patients with decompressive craniectomy.
abstract: OBJECTIVE
  Decompressive craniectomy is an effective therapy to relieve intractable intracranial hypertension following acute brain injury. However, little is known about the optimal timing for cranioplasties in the sub-acute phase. The objective of the present study was to analyse the effect of cranioplasty timing on neurological outcomes.
  
  
  METHODS
  Single-centre observational study.
  
  
  METHODS
  One hundred and forty-seven consecutive patients with decompressive craniectomy and cranioplasty during the course of inpatient neurorehabilitation were identified by means of a retrospective hospital database search. This database contains the following prospectively-entered weekly scores: Barthel-Index (BI), Functional Independence Measure (FIM) and Coma Remission Scale (CRS). Additional clinical data were taken retrospectively from patient charts. Regression analysis was used to identify factors that influenced the end-of-rehabilitation outcome.
  
  
  RESULTS
  Patients with shorter delays to cranioplasty (<86 days) had a better functional outcome than patients with longer delays of >85 days (60 ± 29.5 versus 25 ± 24.1 BI points; p < 0.01, respectively). Age, pre-operative BI and CRS scores were additional independent outcome factors. Complication rates were not different between early and late cranioplasty groups.
  
  
  CONCLUSIONS
  Patients with decompressive craniectomy for management of intracranial hypertension may benefit from early cranioplasty.
authors.affiliation: Department of Neurology, University of Munich, Germany. anbender@med.uni-muenchen.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Bender
authors.forename: Sandrine
authors.initials: S
authors.lastname: Heulin
authors.forename: Stefan
authors.initials: S
authors.lastname: Röhrer
authors.forename: Jan-Hinnerk
authors.initials: JH
authors.lastname: Mehrkens
authors.forename: Volkmar
authors.initials: V
authors.lastname: Heidecke
authors.forename: Andreas
authors.initials: A
authors.lastname: Straube
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfefferkorn
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003399:Craniotomy; D056424:Decompressive Craniectomy; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome