Features of the postoperative period of ultra-early cranioplasty after decompressive cranioectomy in patients with open and closed traumatic brain trauma

INTRODUCTION. Acquired bone defects of the cranial vault occur after surgical treatment for traumatic brain injury, tumor and vascular pathology of the brain. Cranioplasty performed within one month after decompressive cranioctomy, known as ultra-early cranioplasty (ultra-early CP), can improve neurological function with a lower number of concomitant complications.

AIM. To analyze postoperative complications in patients after ultra-early cranioplasty after open and closed traumatic brain injury.

MATERIALS AND METHODS. The data of 19 patients with open traumatic brain injury (study group), aged 18 to 68 years (average age 35.3±1.4 years), who were treated for traumatic brain injury and 21 patients with closed traumatic brain injury (control group), in aged 18 to 69 years (average age 35.7±1.3 years), who underwent ultra-early cranioplasty with a titanium mesh within 4–5 weeks after decompressive craniectomy. In all cases, if the dura mater was damaged, it was hermetically repaired with artificial Xeno Dura TMO sealed with Glue Brain glue to prevent cerebrospinal fluid. In patients of the main and control groups, upon admission for ultra-early cranioplasty, on the tenth day of the postoperative period, and one month after cranioplasty, neurological functions were assessed using the National Stroke Institute of Health (NIHSS) Scale, and the level of consciousness was assessed using the Glasgow Coma Scale.

RESULTS. The obtained results of assessing the level of consciousness according to the SHG, cognitive functions according to the Montreal Cognitive Function Assessment Scale (MoCA), neurological functions according to the National Stroke Scale of the Institute of Health (NIHSS), general disability and the degree of dependence of the patient on outside help – according to the Rankin scale in patients of the study and control groups before ultra-early cranioplasty, by 10 – the 1st day of the postoperative period and a month after the ultra-early cranioplasty did not differ significantly (p>0.05). However, there was a significant improvement a month after the ultra-early cranioplasty, compared with the preoperative condition (p<0.05).

CONCLUSION. Ultra-early cranioplasty should be performed in patients after decompressive cranial trepanation for open and closed craniocerebral trauma as early as possible, subject to mandatory hermetization of the dura mater, since it leads to early recovery of cognitive functions, reduction of disability, restoration of the physiological shape of the cranial vault with the elimination of cosmetic defects and related psychological stress after injuries. Taking into account all the individual characteristics of the patient, ultra-early cranioplasty can be performed in patients with open traumatic brain injury.

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