Optimal Timing of Cranioplasty and Predictors of Overall Complications After Cranioplasty Brain Sunken Volume.xls

Background: The optimal timing of surgery and predictors of overall postoperative complications are still controversial. Objective: To determine the optimal timing of CP. Methods: Patients were divided into intervention group and control group based on brain sinking or not, respectively. Brain sunken volume was calculated by intracranial volume difference before and after CP in a 3-dimensional (3D) way. The main outcomes were overall complications and outcomes at 12-months follow-up after CP. Results: Of the 102 patients enrolled in this study, 56 patients in intervention group and 46 patients in control group. Complications were noted in 30.4% (n = 31), 24 (42.9%) patients in intervention group and 7 (15.2%) patients in control group, with a significant difference (P = 0.003). Thirty-three (58.9%) patients had good outcomes (mRS 0-3) in intervention group and 34 (73.9%) patients had good outcomes in control group, without a statistically significant difference (P = 0.113). Brain sinking (P = 0.005) and KPS score at the time of CP (P = 0.025) were significantly associated with overall postoperative complications. The cut-off value for brain sunken volume was determined as 11.26 cm3 in the ROC curve. The DC-CP interval was not related to brain sunken volume or postoperative complications. Conclusion: Brain sinking and lower KPS score at the time of CP were independent predictors of overall complications after CP. The optimal timing of CP may be determined by tissue window based on brain sunken volume instead of time window based on the DC-CP interval.