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ORIGINAL ARTICLE
Year : 2019  |  Volume : 52  |  Issue : 4  |  Page : 122-126

Simultaneous or staged operation? Timing of cranioplasty and ventriculoperitoneal shunt after decompressive craniectomy


1 Department of Surgery, Division of Neurosurgery, Maykay Memorial Hospital, Taipei; Institute of Nano Engineering and Microsystems; National Tsing Hua University; Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
2 Department of Surgery, Division of Neurosurgery, Maykay Memorial Hospital, Taipei, Taiwan
3 Department of Surgery, Division of Neurosurgery, Maykay Memorial Hospital, Taipei; Department of Medicine, Mackay Medical College, Taiwan
4 Institute of Biomedical Engineering, National Tsing Hua University; Frontier Research Center on Fundamental and Applied Science of Matters, National Tsing Hua University, Hsinchu, Taiwan

Correspondence Address:
Dr. Cheng-Chia Tsai
Department of Surgery, Division of Neurosurgery, Maykay Memorial Hospital, Taipei; Department of Medicine, Mackay Medical College, Hsinchu
Taiwan
Prof. Dehui Wan
No. 101, Section 2 Kuang-Fu Road, Hsinchu
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_18_19

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Aims: Cranioplasty and ventriculoperitoneal shunt (VPS) are common procedures for patients who undergo decompressive craniectomy. The ideal time for these two procedures remains controversial. Settings and Design: This is a retrospective, single institute, chart review comparing the complications associated with simultaneous and staged cranioplasty and VPS. Materials and Methods: From January 2012 to December 2017, 56 patients who underwent both cranioplasty and VPS surgery at our hospital were separated into simultaneous or staged operation groups. We compared the demographic data and complications, including infections, subdural or epidural hemorrhage, and revision surgery between the groups. Statistical Analysis Used: Independent Student's t-test was used for analysis of continuous variables, and Fisher's exact test was used for categorical data. MedCalc (version: 18.11) was used to perform all analysis. Results: Nineteen patients underwent simultaneous cranioplasty and VPS, whereas 37 underwent staged operation. Etiologies for craniectomy included traumatic brain injury, infarction, spontaneous subarachnoid hemorrhage, and spontaneous intracerebral hemorrhage. There were no significant differences in the baseline characteristics between the groups. The overall complication rate was 14.3%. Three (15.8%) patients experienced complications in the simultaneous group: One (5.3%) with skin infection and two (10.5%) with overdrainage. Five (13.5%) patients experienced complications in the staged group: three (10.8%) with skin infections, one with central nervous system (CNS) infections, and one with both skin and CNS infections. Overall complications, wound infections, CNS infections, overdrainage, and revision surgery showed no significant differences between the groups. Conclusions: Simultaneous cranioplasty and VPS showed complication rates similar to those of staged operation.


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