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The Scientific Issues of Ternopil Volodymyr Hnatiuk National Pedagogical University Series pedagogy
Von Марк Ю. Глухенький, M. V. Kadzhaia, Oleksandr S. Hotin und 1 weiteren.
Inhalt auf Englisch
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To substantiate the rationale for determining the duration of the intermediate postoperative period before cranioplasty (CP) to facilitate the timely detection, prevention, and treatment of late complications of decompressive craniectomy (DC).
A prospective single-center analysis was conducted in 100 patients treated at the Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine in 2022–2025. All patients underwent CP and, when indicated, ventriculoperitoneal shunting (VPS). Patients were divided into three groups: Group 1 (n = 32) was transferred to the Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine 3–7 days after the primary surgery; Group 2A (n = 44) was transferred from neurological, rehabilitation, or palliative care departments several months after the primary surgery; and Group 2B (n = 24) was referred by the medical services of military units. Clinical status, timing of CP, incidence of post-traumatic hydrocephalus (PTH), sequence of CP and VPS, complication rates, and duration of antibiotic therapy (ABT) were analyzed.
Cranioplasty was performed in 85 (85.0%) patients: 18 (56.3%) in Group 1, 43 (97.7%) in Group 2A, and 24 (100%) in Group 2B. The interval between DC and CP differed significantly among the groups: 2.5 ± 0.8, 5.2 ± 1.3, and 7.4 ± 2.1 months, respectively (p<0.001). Post-traumatic hydrocephalus was diagnosed in 30.0% of patients, most frequently in Group 1 (50.0%) and Group 2A (31.8%); no cases were recorded in Group 2B. Ventriculoperitoneal shunting was performed earlier in Group 1 than in Group 2A (38 ± 9 vs. 102 ± 24 days, p < 0.001). Simultaneous CP and VPS were performed in 60.0% of patients with PTH. The rate of infectious complications was 3.0%. These complications occurred only in patients who received ABT for 3–5 days, whereas no infections were recorded with treatment courses lasting 6–10 days. Early and intermediate CP were not associated with an increased incidence of infectious or clinically significant neurological complications.
Cranioplasty after DC for gunshot wounds to the brain is not only a reconstructive procedure but also a component of “surgical rehabilitation.” Determining the duration of the intermediate postoperative period before closure of the cranial defect enables active neurosurgical surveillance and timely diagnosis of PTH, paradoxical brain herniation, and other complications. Personalized selection of the timing and sequence of CP and VPS, the use of individualized 3D-printed titanium implants, and prolonged ABT may facilitate safe performance of the procedure within a clinically justified timeframe.
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