Tomar Kapil, Roy I D, Kumar Singh Anup, Yadav Rekha Chintamani
Division of Oral and Maxillofacial Surgery, AFMC, Pune, India.
Head of Department, Division of Oral and Maxillofacial Surgery, AFMC, Pune, India.
Br J Oral Maxillofac Surg. 2024 Dec;62(10):944-949. doi: 10.1016/j.bjoms.2024.07.003. Epub 2024 Jul 26.
Cranioplasty performed after a decompressive craniectomy (DC) for traumatic brain injury (TBI), stroke, or aneurysmal bleed has a role of restoring cerebral protection and craniofacial cosmesis as well as improving neuromotor function. There has been no consensus with regards to the ideal timing of cranioplasty (CP) after DC. A retrospective cohort study was carried out at a tertiary care hospital on patients who had undergone early (less than or equal to 12 weeks) and late (greater than 12 weeks) cranioplasty using autologous cranial bone after DC. Functional independence measure (FIM) tools were used to compare neuromotor and cognitive function outcome between the two groups. Appropriate statistical tools were used to compare neuromotor and cognitive function improvement as well as complication rates between early and late cranioplasty. A total of 31 adult patients of cranioplasty (21 male and 10 female) were evaluated. Sixteen had undergone early and 15 late cranioplasty. Comparison for neuromotor and cognitive function using FIM tools revealed statistically significant neuromotor and cognitive advantages in the early cranioplasty group. Overall complication rates between the two groups varied but were statistically insignificant. Performing an early cranioplasty provides advantages of improvement of neuromotor and cognitive function through early restoration of cerebrospinal fluid and intracerebral haemo-dynamics. It further avoids the potential problems of developing the 'Syndrome of the Trephined' (otherwise known as sinking skin flap syndrome) and resorption of the autologous bone.
对于创伤性脑损伤（TBI）、中风或动脉瘤性出血患者，在减压性颅骨切除术后进行颅骨成形术，具有恢复脑保护、改善颅面美观以及改善神经运动功能的作用。关于减压性颅骨切除术后颅骨成形术（CP）的理想时机，目前尚无共识。在一家三级医疗中心进行了一项回顾性队列研究，研究对象为减压性颅骨切除术后接受早期（小于或等于12周）和晚期（大于12周）自体颅骨颅骨成形术的患者。使用功能独立性测量（FIM）工具比较两组患者的神经运动和认知功能结果。使用适当的统计工具比较早期和晚期颅骨成形术之间神经运动和认知功能的改善情况以及并发症发生率。总共评估了31例接受颅骨成形术的成年患者（21例男性和10例女性）。其中16例接受了早期颅骨成形术，15例接受了晚期颅骨成形术。使用FIM工具对神经运动和认知功能进行比较，结果显示早期颅骨成形术组在神经运动和认知方面具有统计学意义的优势。两组的总体并发症发生率有所不同，但无统计学意义。早期进行颅骨成形术具有通过早期恢复脑脊液和脑内血流动力学来改善神经运动和认知功能的优势。它还可以避免出现“颅骨钻孔综合征”（又称下陷皮瓣综合征）和自体骨吸收等潜在问题。
