Safety and Efficacy of Simultaneous Versus Staged Cranioplasty and Ventriculoperitoneal Shunt Placement After Decompressive Craniectomy: A Retrospective Cohort Study.

Abstract

Decompressive craniectomy (DC) is lifesaving for refractory intracranial hypertension but frequently leaves a cranial defect and may be followed by hydrocephalus. The optimal timing of cranioplasty (CP) and ventriculoperitoneal shunt (VPS) placement remains controversial. We retrospectively reviewed 40 adults who underwent both CP and VPS after DC at a regional trauma hospital in Taiwan between 2015 and 2022. Patients were grouped as staged surgery (n = 16) or simultaneous surgery (n = 24). Postoperative complications, 3-month Glasgow Coma Scale (GCS), ECOG Performance Status (ECOG-PS), mortality, and hospital stay were compared. Overall complication rates were identical in the staged and simultaneous groups (25.0% vs. 25.0%, P = 1.000). No significant between-group differences were found in age, sex, body mass index, comorbidities, 3-month GCS (11 +/- 2.6 vs. 12 +/- 3.0, P = 0.694), ECOG-PS (3.6 +/- 1.0 vs. 3.5 +/- 0.9, P = 0.462), mortality (13% vs. 4.2%, P = 0.553), or hospital stay (42 +/- 17 vs. 53 +/- 20 days, P = 0.089). Simultaneous CP and VPS placement was not associated with increased perioperative complications or worse short-term functional outcomes compared with staged surgery in this small sample. In appropriately selected patients, the simultaneous strategy appears to be a safe and practical alternative in our hands.