title: Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy: Staged Surgery Is Associated with Fewer Postoperative Complications.
abstract: OBJECTIVE
  Decompressive craniectomy (DC) requires later cranioplasty (CP) in survivors. However, if additional ventriculoperitoneal shunt (VPS) placement due to shunt-dependent hydrocephalus is necessary, the optimal timing of both procedures still remains controversial. We therefore analyzed our computerized database concerning the optimal timing of CP and VPS regarding postoperative complications.
  
  
  METHODS
  From 2009-2014, 41 cranioplasty procedures with simultaneous or staged VPS placement were performed at the authors' institution. Patients were stratified into two groups according to the time from CP to VPS ("simultaneous" and "staged"). Patient characteristics, timing of CP and VPS, as well as procedure-related complications, were assessed and analyzed.
  
  
  RESULTS
  Overall CP and VPS were performed simultaneously in 41% and in staged fashion in 59% of the patients. The overall complication rate was 27%. Patients who underwent simultaneous CP and VPS suffered significantly more often from complications compared with patients who underwent staged CP and VPS procedures (47% vs. 12%; P = 0.03). Patients with simultaneous CP and VPS had a significantly higher rate of infectious postoperative complications compared with patients with staged procedures (P = 0.003). On multivariate analysis, simultaneous CP and VPS procedure was the only significant predictor of postoperative complication after CP and VPS (P = 0.03).
  
  
  CONCLUSIONS
  We provide detailed data on surgical timing and complications for cranioplasty and ventriculoperitoneal shunt placement after DC. The present data suggest that patients who undergo staged CP and VPS procedures might benefit from a lower complication rate. This might influence future surgical decision making regarding optimal timing of CP and VPS placement.
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany. Electronic address: patrick.schuss@ukb.uni-bonn.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schuss
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
authors.forename: Valeri
authors.initials: V
authors.lastname: Borger
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
authors.forename: Ági
authors.initials: Á
authors.lastname: Güresir
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
authors.forename: Erdem
authors.initials: E
authors.lastname: Güresir
mesh_terms: D000328:Adult; D000368:Aged; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010347:Patient Care Planning; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011379:Prognosis; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
keywords: Cranioplasty; Decompressive craniectomy; Ventriculoperitoneal shunt