Efficacy and safety of early cranioplasty with topical anti-adhesive agent administration; preliminary report

Abstract

PURPOSE : “Craniectomy” may bring on several problems including cosmetic dysfigurement, progressive neurologic deterioration, and severe adhesion during skull restoration. Cranioplasty is the proven solution for these annoyances, although there was no established consensus for surgical timing. We herein study the efficacy and safety of early cranioplasty, within one month following first surgical decompression that had been performed with topical application of anti-adhesive agent for prevention of brain injury during dissection for revision.

MATERIALS AND METHODS : During the past 1 year, nineteen patients were enrolled in the present study. Serial brain computed tomogram (CT) was obtained to demonstrate resolution of brain swelling. Cerebral blood flow (CBF) was also checked by perfusion CT both one week before and two weeks after cranioplasty. During the operative procedure, efficacy of anti-adhesive agent was assessed through elapsed time and blood loss. Neurologic status and symptoms were also assessed. Fifteen patients were selected as control group, who underwent cranioplasty without using anti-adhesive agent.

RESULTS : Primary causes for craniectomy were traumatic lesions in 13 and spontaneous bleeds in 6, retrospectively. The mean duration for cranioplasty was 28.4 days after first operation. The mean period of dissection was 14.42 minutes (p<0.0001). Twelve patients (63%) showed immediate neurological improvement postoperatively. On CBF assessment, there was a statistically significant increase in thalamus (p=0.16) and cortical region (p=0.03) in these patients. There was not surgery related infection.

CONCLUSION : According to present result, early cranioplasty guarantees satisfactory securing and faster neurologic improvement without any complications. Anti-adhesive agent also offers good dissection plane without damage to the underlying brain tissue, and ultimate time-saving. So, we suggest that cranioplasty might be sufficiently early performed, in selected cases.