Analysis of Causes of Complications and Prognostic Factors After Titanium Mesh Ultra-Early Cranioplasty Following Decompressive Craniectomy for Craniocerebral Trauma.

OBJECTIVE

Craniocerebral trauma is one of the main causes of death and disability worldwide. Decompressive craniectomy is a common emergency measure in the treatment of craniocerebral trauma, aimed at relieving intracranial pressure. However, cranial bone reconstruction (CP) following this surgery is crucial for the patient's long-term recovery. Despite this, research on complications and prognostic factors after ultra-early cranioplasty remains limited. Therefore, this study aims to explore the complications of ultra-early cranioplasty with titanium mesh and its impact on prognosis.

METHODS

From January 2020 to November 2022, 44 patients with craniocerebral trauma who needed ultra-early CP after decompressive craniectomy were collected. The basic data of the National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale, modified Rankin Scale, and Montreal Cognitive Assessment scores of patients were collected, and the complications and prognosis of patients 3 months after operation were collected. Multivariate logistic regression was used to analyze the prognostic factors.

RESULTS

Compared with preoperative, the postoperative NIHSS score of patients with ultra-early CP decreased, the postoperative Glasgow Coma Scale score increased, the postoperative modified Rankin Scale score decreased (P < 0.05), and the postoperative Montreal Cognitive Assessment score was higher. Postoperative complications occurred in 42 patients with ultra-early CP. There were 37 complications, including 7 cases of hydroaccumulation, 18 cases of hematocele, 11 cases of pneumatosis, 3 cases of scalp swelling, 2 cases of epilepsy, 10 cases of hydrocephalus, and 1 case of intracranial infection, and no incision infection occurred. Age and postoperative NIHSS score were related factors affecting the poor prognosis of ultra-early CP patients (P < 0.05).

CONCLUSIONS

Ultra-early CP can promote the recovery of neurological function, reduce the disturbance of consciousness, improve daily living ability, and improve cognitive function in patients with craniocerebral trauma, but there is a high risk of postoperative complications. In addition, age and postoperative NIHSS score are related factors affecting the poor prognosis of ultra-early CP patients.