The effect of cranioplasty on outcomes and complications of unresponsive wakefulness syndrome and minimally responsive state

Elena Aidinoff; Hiela Lehrer; Ilana Gelernter; Ilil Dayan; Adi Kfir; Lilach Front; Ana Oksamitny; Amiram Catz

doi:10.1071/IB23124

RESEARCH ARTICLE (Open Access)

Next Contents Vol 25(3)

The effect of cranioplasty on outcomes and complications of unresponsive wakefulness syndrome and minimally responsive state

Elena Aidinoff

^A ^B ^* , Hiela Lehrer ^A , Ilana Gelernter ^B , Ilil Dayan ^A , Adi Kfir ^A , Lilach Front ^A , Ana Oksamitny ^A and Amiram Catz ^A ^B

+ Author Affiliations

- Author Affiliations

^A Intensive Care and Consciousness Rehabilitation Department, Loewenstein Rehabilitation Medical Center, 278 Achuza St., Raanana 4355840, Israel.

^B Department of Rehabilitation and School of Mathematics, Tel Aviv University, Tel Aviv, Israel.

^* Correspondence to: aidinofe@clalit.org.il

Handling Editor: Grahame Simpson

Brain Impairment 25, IB23124 https://doi.org/10.1071/IB23124

Submitted: 7 December 2023 Accepted: 29 August 2024 Published: 16 September 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Australasian Society for the Study of Brain Impairment. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY).

Abstract

Background

Studies that have shown neurological improvement following cranioplasty (CP) after decompressive craniectomy (DC) in patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) did not include control groups. The aim of this study was to assess the justification of CP for these patients.

Methods

Data were collected from medical records of inpatients with UWS and MCS admitted between 2002 and 2018.

Results

Of the 144 participants (mean age 40 years, 76% males, 75% in UWS), 37% had CP following DC. The Loewenstein Communication Scale (LCS) gain was 12 ± 17 and 16 ± 17 for the control and study patients, respectively. The corresponding consciousness recovery rate (based on Coma Recovery Scale-Revised scores) was 51% and 53%, respectively. One-year survival rates were 0.80 and 0.93, and 5-year survival rates were 0.67 and 0.73, respectively. Mean outcome values were higher for the study group, but the differences between the groups did not reach statistical significance.

Conclusions

The study did not demonstrate that CP increases brain recovery or survival. Nevertheless, it showed that CP did not decrease them either, and it did not increase complications rate. The findings, therefore, support offering CP to patients with UWS and MCS as CP does not increase risks and can achieve additional goals for these patients.

Keywords: cranioplasty, decompressive craniectomy, disorders of consciousness, minimal consciousness state, minimally responsive state, outcomes, unresponsive wakefulness syndrome, vegetative state.

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