Editorial on the Research Topic
Decompressive Craniectomy and Cranioplasty - Challenges and Chances
Cranioplasty is an ancient operation with the early records going back to the Incan empire in the 15th century. Surgery is predicated on the central tenants of ameliorating abnormal pathology and restoring defective anatomy (1). The Incan surgeon was surely compelled by the natural human inclination to fix that which appears broken. And what could be more convincing and primally ‘surgical’ than the need to repair a skull defect? However, even with such an apparently simple procedure- hidden complexities and obscure pitfalls abound. This themed Frontiers in Surgery issue addresses some of these challenges.
Firstly, in whom should the surgeon operate? While the controversy of decompressive craniectomies in trauma remain stubborn to any concluding argument, decompressions in the context of acute ischaemic stroke provide ample opportunities for those inclined towards cranioplasty insertion. The indications are important and require examination, not least in those without full capacity. Is this a cosmetic operation or a therapeutic one? Are we reducing future risk of injury? What are the neuro-cognitive implications of cranioplasty (or not performing cranioplasty)? And in what situations can we avoid cranioplasty altogether by replacing the bone at the time of primary surgery, for example after haematoma evacuation. These and many more questions pass through our minds during the process of consent. Our ability to weigh and balance these depends fundamentally upon research findings and our understanding of the data as applied to an individual patient. Using qualitative methods, Pandit et al. (2) investigate the question of whether there is a need for protection protocols in patients with craniectomy during non-ambulatory movements. Then adding to the conversation of patient selection and prognostication of surgery Lim et al. (3) present a multicentre study exploring intracranial pressure thresholds as a marker of adequacy in large territory ischaemic stroke.
Paediatric patients are a specific challenge. Their growing skulls require additional considerations. Bandyopadhyay (4) gives a brief overview of some key questions and concepts and the need for further research. An important question in cranioplasty is what material we should implant. While those early practitioners used a variety of precious metals and gourds, later practitioners have trialled autologous grafts, metals including titanium plates/meshes, ceramics, plastics, and latterly a variety of complex osteogenic materials. Augmentation with antibiotics have been used as have a plethora of structural variations. The work of Zaed et al. (5) to assesses outcomes in paediatric patients undergoing cranioplasty with custom-made porous hydroxyapatite plates is an example of how these questions need to be specifically addressed in children where adult findings may not immediately translate.
Next, how do we optimize the surgical implantation procedure itself. The examination of surgical workflows (including pre and postoperative aspects) and their impact is a vogue topic. He et al. (6) offer a perioperative paradigm and discuss how workflow can influence postoperative complications in the context of polyetheretherketone (PEEK) plates. Finally, the review by Mee et al. (7) gives a timely summary of the state of knowledge in the field, and show that despite being one of the first neurosurgical operations it is clear this procedure is still evolving and there remains significant room for refinement.
Statements
Author contributions
CSH, CH and JH all wrote the manuscript. All authors contributed to the article and approved the submitted version.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1.
Alkhaibary A Alharbi A Alnefaie N Almubarak AO Aloraidi A Khairy S . Cranioplasty: a comprehensive review of the history, materials, surgical aspects, and complications. World Neurosurg. (2020) 139:445–52. 10.1016/j.wneu.2020.04.211
2.
Pandit AS Singhal P Khawari S Luoma AM Ajina S Toma AK . The need for head protection protocols for craniectomy patients during rest, transfers and turning. Front in Surg. (2022) In Press. 10.3389/fsurg.2022.918886
3.
Lim JX Liu SJ Cheong TM Saffari SE Han JX Chen MW . Intracranial pressure as an objective biomarker of decompression adequacy in large territory infarction: a multicenter observational study. Front in Surg. (2022) 9:823899 In Press. 10.3389/fsurg.2022.823899
4.
Bandyopadhyay S . Decompressive craniectomy in paediatric patients. Front in Surg. (2022) In Press. 10.3389/fsurg.2022.860896
5.
Zaed I Safa A Spennato P Mottolese C Chibbaro S Cannizzaro D et al A Multicentric european clinical study on custom-made porous hydroxyapatite cranioplasty in a pediatric population. Front in Surg. (2022) 9:856743 In Press. 10.3389/fsurg.2022.848620
6.
He Z Ma Y Yang C Hui J Mao Q Gao G et al A perioperative paradigm of cranioplasty with polyetheretherketone: comprehensive management for preventing postoperative complications. Front in Surg. (2022) 21(9):856743. 10.3389/fsurg.2022.856743
7.
Mee H Anwar F Timofeev I Owen N Grieve K Whiting G et al Cranioplasty: a multi-disciplinary approach. Front in Surg. (2022) 9:864385 In Press. 10.3389/fsurg.2022.864385
Summary
Keywords
cranioplasty, decompression, neurosurgery, trauma, stroke, complication
Citation
Hill CS, Henker C and Höhne J (2022) Editorial: Decompressive Craniectomy and Cranioplasty - Challenges and Chances. Front. Surg. 9:945290. doi: 10.3389/fsurg.2022.945290
Received
16 May 2022
Accepted
20 May 2022
Published
09 June 2022
Volume
9 - 2022
Edited by
Philipp Taussky, The University of Utah, United States
Updates
Copyright
© 2022 Hill, Henker and Höhne.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ciaran Scott Hill ciaran.hill@ucl.ac.uk
Specialty section: This article was submitted to Neurosurgery, a section of the journal Frontiers in Surgery
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.