Is preoperative brain midline shift a determinant factor for neurological improvement after cranioplasty?

Chun Hsien Lin, Jen Tsung Yang, Ting Chung Wang, Martin Hsiu Chu Lin, Wan Chun Cheng, Ming Hsueh Lee*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

4 Scopus citations

Abstract

In patients with traumatic brain injury, the degree of brain midline shift is related to prognosis. In this study, we evaluated the impact of the presence of a preoperative brain midline shift on the Glasgow Coma Scale (GCS) scores and muscle power (MP) improvement after cranioplasty. Methods: In this 6-year retrospective cohort study, we compared cranioplasty patients from Taiwan with and without a preoperative brain midline shift. We assigned the patients to the following two groups: the midline shift group and the nonmidline shift group. The GCS score and MP contralateral to the lesion site were recorded and analyzed both prior to and 1 year after the operation. Results: We enrolled 56 cranioplasty patients (35 patients with a midline shift and 21 without a midline shift) and analyzed their complete clinical characteristics. There were significant improvements in the GCS (p=0.0078), arm MP (p=0.0056), and leg MP (p=0.0006) scores after cranioplasty. There was also a significant improvement in the GCS score in the brain midline shift group (0.4±0.149 in the brain midline shift group vs. 0.05±0.48 in the nonmidline shift group, p=0.03). Conclusion: For patients who underwent craniectomy, an improvement in neurological function 1 year after cranioplasty was observed. The patients with brain midline shift showed more improvement in consciousness after cranioplasty than those without a brain midline shift. The presence of a preoperative brain midline shift may be an isolated determinant for the prediction of the outcome after cranioplasty.

Original languageEnglish
Pages (from-to)577-582
Number of pages6
JournalJournal of the Formosan Medical Association
Volume114
Issue number7
DOIs
StatePublished - 01 07 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2013.

Keywords

  • Brain midline shift
  • Craniectomy
  • Cranioplasty
  • Neurological improvement

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