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.背景：手术最佳时机与术后总体并发症的预测因素目前仍存在争议。目的：明确CP的最佳手术时机。方法：本研究依据是否存在脑下陷（brain sinking）将患者分别纳入干预组与对照组。采用三维（3D）方式计算CP术前与术后的颅内体积差，以获得脑下陷体积。主要结局指标为术后总体并发症情况，以及CP术后12个月随访的预后情况。结果：本研究共纳入102例患者，其中干预组56例，对照组46例。共计31例（30.4%）患者出现并发症，其中干预组24例（占该组的42.9%），对照组7例（占该组的15.2%），组间差异具有统计学意义（P=0.003）。干预组中33例（占该组的58.9%）患者预后良好（改良Rankin量表（Modified Rankin Scale, mRS）评分0~3分），对照组为34例（占该组的73.9%），组间差异无统计学意义（P=0.113）。脑下陷（P=0.005）与CP术前的卡氏功能状态评分（Karnofsky Performance Scale, KPS）（P=0.025）均与术后总体并发症显著相关。经受试者工作特征曲线（Receiver Operating Characteristic, ROC）分析，脑下陷体积的截断值确定为11.26 cm³。DC-CP间隔时间与脑下陷体积及术后并发症均无相关性。结论：脑下陷与CP术前较低的KPS评分是CP术后总体并发症的独立预测因素。CP的最佳手术时机或可基于脑下陷体积确定组织窗，而非依据DC-CP间隔时间确定时间窗。