title: Impact of timing of cranioplasty on hydrocephalus after decompressive hemicraniectomy in malignant middle cerebral artery infarction.
abstract: OBJECTIVE
  Patients with malignant middle cerebral artery infarction frequently develop hydrocephalus after decompressive hemicraniectomy. Hydrocephalus itself and known shunt related complications after ventriculo-peritoneal shunt implantation may negatively impact patientś outcome. Here, we aimed to identify factors associated with the development of hydrocephalus after decompressive hemicraniectomy in malignant middle cerebral artery infarction.
  
  
  METHODS
  A total of 99 consecutive patients with the diagnosis of large hemispheric infarctions and the indication for decompressive hemicraniectomy were included. We retrospectively evaluated patient characteristics (gender, age and selected preoperative risk factors), stroke characteristics (side, stroke volume and existing mass effect) and surgical characteristics (size of the bone flap, initial complication rate, time to cranioplasty, complication rate following cranioplasty, type of implant, number of revision surgeries and mortality).
  
  
  RESULTS
  Frequency of hydrocephalus development was 10% in our cohort. Patients who developed a hydrocephalus had an earlier time point of bone flap reimplantation compared to the control group (no hydrocephalus=164±104days, hydrocephalus=108±52days, p<0.05). Additionally, numbers of revision surgeries after cranioplasty was associated with hydrocephalus with a trend towards significance (p=0.08).
  
  
  CONCLUSIONS
  Communicating hydrocephalus is frequent in patients with malignant middle cerebral artery infarction after decompressive hemicraniectomy. A later time point of cranioplasty might lead to a lower incidence of required shunting procedures in general as we could show in our patient cohort.
authors.affiliation: Department of Neurosurgery, Universitätsmedizin Charite, Berlin, Germany. Electronic address: tobias.finger@charite.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Finger
authors.affiliation: Department of Neurosurgery, Universitätsmedizin Charite, Berlin, Germany.
authors.forename: Vincent
authors.initials: V
authors.lastname: Prinz
authors.affiliation: Department of Neurosurgery, Universitätsmedizin Charite, Berlin, Germany.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Schreck
authors.affiliation: Department of Neurosurgery, Universitätsmedizin Charite, Berlin, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Pinczolits
authors.affiliation: Department of Neurosurgery, Universitätsmedizin Charite, Berlin, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Bayerl
authors.affiliation: Department of Neurology, Universitätsmedizin Charite, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Liman
authors.affiliation: Department of Neurosurgery, Universitätsmedizin Charite, Berlin, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Woitzik
authors.affiliation: Department of Neurosurgery, Universitätsmedizin Charite, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
mesh_terms: D000328:Adult; D056424:Decompressive Craniectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology*; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019651:Plastic Surgery Procedures / Q000592:standards* / Q000706:statistics & numerical data; D013997:Time Factors
keywords: Cranioplasty; Hemicraniectomy; Hydrocephalus; Malignant middle cerebral artery infarction; Shunt dependence