Assessment of functional recovery after cranioplasty

Authors

  • Girish K. Madhavan Department of Neurosurgery, Government Medical College, Kottayam, Kerala, India
  • Philip Issac Department of Neurosurgery, Government Medical College, Kottayam, Kerala, India
  • Balakrishnan P. Kunjan Department of Neurosurgery, Government Medical College, Kottayam, Kerala, India
  • Tom Jose Department of Neurosurgery, Government Medical College, Kottayam, Kerala, India
  • Ajax John Department of Neurosurgery, Government Medical College, Kottayam, Kerala, India

DOI:

https://doi.org/10.18203/2349-2902.isj20212718

Keywords:

Decompressive craniectomy, Syndrome of the trephined, Cranioplasty, Barthel ADL score

Abstract

Background: Cranioplasty is done after decompressive craniectomy surgeries either for cosmetic reasons or to afford protection against the development of the syndrome of the trephined which is deterioration after cranial decompression procedures. The aim of the study was to study functional recovery after cranioplasty based on improvement of Barthel activities of daily living (ADL) score.

Methods: This was a prospective study done over 6 months period, December 2020 to May 2021. The functional recovery following cranioplasty was assessed based on improvement in Barthel ADL score. Pre-operative and post-operative Barthel ADL score after 3 months after cranioplasty of patients are found out. The change in Barthel score is analyzed and significance found out using paired t test.

Results: In this study, 62 patients were included. 42 patients had improvement of ADL score. 14 patients had no change and 6 patients had worsening of score. After cranioplasty, ADL score has improved and it was statistically significant (p<0.001). Also, patients with low level of dependency (level 1, 2 and 3) have decreased in number and patients with higher levels of dependency (level 4 and 5) have increased in number after the surgery, suggesting that there is shift of patients from lower level of dependency to higher levels.

Conclusions: Cranioplasty seems to offer patients clear benefits in terms of neurological improvement in many cognitive domains as well as in quality of life. Hence, cranioplasty advocated for functional/neurological recovery rather than cosmetic reasons.

Metrics

Metrics Loading ...

Author Biographies

Girish K. Madhavan, Department of Neurosurgery, Government Medical College, Kottayam, Kerala, India

department of neurosurgery

Philip Issac, Department of Neurosurgery, Government Medical College, Kottayam, Kerala, India

department of neurosurgery

Balakrishnan P. Kunjan, Department of Neurosurgery, Government Medical College, Kottayam, Kerala, India

department of Neurosurgery

Tom Jose, Department of Neurosurgery, Government Medical College, Kottayam, Kerala, India

department of neurosurgery

Ajax John, Department of Neurosurgery, Government Medical College, Kottayam, Kerala, India

Department of Neurosurgery

References

Jung HJ, Kim DM, Kim SW. Paradoxical transtentorial herniation caused by lumbar puncture after decompressive craniectomy. J Korean Neurosurg Soc. 2012;51(2):102-4.

Mokri B. Orthostatic headaches in the syndrome of the trephined: resolution following cranioplasty. Headache. 2010;50(7):1206-11.

Ashayeri K, Jackson ME, Huang J, Brem H, Gordon CR. Syndrome of the Trephined: A Systematic Review. Neurosurgery. 2016;79(4):525-34.

Physiopedia contributors. Barthel Index, 2019. Available at: https://www.physio-pedia.com/index.php?title=Barthel_Index&oldid=222910. Accessed on 22 February 2021.

Sarov M, Guichard JP, Chibarro S, Guettard E, Godin O, Yelnik A, et al. Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction. Stroke. 2010;41(3):560-2.

Maekawa M, Awaya S, Teramoto A. Cerebral blood flow (CBF) before and after cranioplasty performed during the chronic stage after decompressive craniectomy evaluated by xenon-enhanced computerized tomography (Xe-CT) CBF scanning. No Shinkei Geka. 1999;27(8):717-22.

Krishnan P, Bhattacharyya AK, Sil K, De R. Bone flap preservation after decompressive craniectomy--experience with 55 cases. Neurol India. 2006;54(3):291-2.

Schirmer CM, Ackil AA, Malek AM. Decompressive Craniectomy. Neurocrit Care. 2008;8(3):456-70.

Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61-5.

Agner C, Dujovny M, Gaviria M. Neurocognitive assessment before and after cranioplasty. Acta Neurochir (Wien). 2002;144(10):1033-40.

Stefano C, Sturiale C, Trentini P, Bonora R, Rossi D, Cervigni G, et al. Unexpected neuropsychological improvement after cranioplasty: a case series study. Br J Neurosurg. 2012;26(6):827-31.

Stiver SI, Wintermark M, Manley GT. Reversible monoparesis following decompressive hemicraniectomy for traumatic brain injury. J Neurosurg. 2008;109(2):245-54.

Downloads

Published

2021-06-28

Issue

Section

Original Research Articles