title: Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures.
abstract: OBJECTIVE
  Some patients with severe brain swelling treated with decompressive craniectomy may develop hydrocephalus. Consequently, these patients require cranioplasty and a ventriculoperitoneal (VP) shunt to relieve the hydrocephalus. However, there is no consensus as to the timing of the cranioplasty and VP shunt placement in patients requiring both. The authors assessed the results of performing cranioplasty and VP shunt placement at the same time in patients with cranial defects and hydrocephalus.
  
  
  METHODS
  A retrospective review was performed of 51 patients who had undergone cranioplasty and VP shunt operations after decompressive craniectomy for refractory intracranial hypertension between 2003 and 2012 at the authors' institution. Patient characteristics, data on whether the operations were performed simultaneously, brain bulging, hydrocephalus, cranial defect size, and complications were analyzed.
  
  
  RESULTS
  The overall complication rate was 43% (22 of 51 patients). In 32 cases, cranioplasty and VP shunt placement were performed at the same time. Complications included subdural hematoma, subdural fluid collection, and infection. The group undergoing cranioplasty and VP shunt placement at the same time had higher complication rates than the group undergoing the procedures at different times (56% vs 21%, respectively). The severity of complications was also greater in the former group. Patients with severe brain bulging had higher complication rates than did those without brain bulging (51% vs 0%, respectively). Cranial defect size, severity of hydrocephalus, indication for decompressive craniectomy, age, sex, and interval between decompressive craniectomy and subsequent operation did not affect complication rates.
  
  
  CONCLUSIONS
  Patients undergoing cranioplasty and VP shunt placement at the same time had higher complication rates, especially those with severe brain bulging.
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
authors.forename: Juneyoung
authors.initials: J
authors.lastname: Heo
authors.forename: Sukh Que
authors.initials: SQ
authors.lastname: Park
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Cho
authors.forename: Jae Chil
authors.initials: JC
authors.lastname: Chang
authors.forename: Hyung-Ki
authors.initials: HK
authors.lastname: Park
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000601:surgery; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
keywords: ICH = intracerebral hemorrhage; SAH = subarachnoid hemorrhage; VP = ventriculoperitoneal; complication; cranioplasty; traumatic brain injury; ventriculoperitoneal shunt