Therapeutic efficacy of cranioplasty post decompressive craniectomy for traumatic brain injury: A retrospective study

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Rohit Sharma, Lalit Janjani, Vishal Kulkarni, Seema Patrikar, Shailey Singh

Abstract

Purpose

Autologous bone as removed at the time of decompressive craniectomy (DC) is always the first choice for cranioplasty. The aim of the present study was to evaluate the therapeutic efficacy of cranioplasty post-DC by measuring the changes in functional independence measure (FIM) score, to draw a comparison with pre-cranioplasty and the difference in outcome of cases managed among the 2 groups (group-I: Autologous bone, group-II: Titanuim mesh).

Materials & Methods

Forty seven patients (36 males /11 females) who underwent unilateral cranioplasty post DC for traumatic brain injury (TBI) at our institute from 2008 to 2017 were included in this analytical single institutional retrospective study design. The primary binary predictor variable was cranioplasty (autologous bone/mesh). The primary outcome variables of interest were increased/ decreased/ unchanged FIM scores. The secondary outcome variables included evaluation of immediate complications. Mann-Whitney U test was used to evaluate the difference between the scores.

Results

Group-I (n=26) had undergone cranioplasty using autologous bone flap. Group-II (n=21) cases had undergone cranioplasty using dynamic titanium mesh. Increase in FIM score (motor) for group-I (p=.01278) and group-II (p=.00112) were statistically significant. Increase in FIM score (cognition) for group-I (p=.17384) and group-II (p=.9492) were statistically insignificant. Evaluation of primary outcome variable (i.e. increased/decreased/unchanged FIM scores) and secondary outcome variables (i.e. immediate complications) revealed statistically insignificant difference between the two groups with respect to improvement (p=0.51).

Conclusion

The present study demonstrated that cranioplasty, irrespective of the material, after DC in patients with TBI results in a significant functional improvement apart from form and esthetics.

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