Cranioplasty after stroke

garychleung

PIG Meeting: 8th July 2021

59yo lady who had a haemorrhagic stroke 6/12 ago, for titanium cranioplasty. Residual left hemiparesis

Background:

  • Haemorrhagic CVA – SAH + intraparenchymal bleeding. Decompressive craniectomy. 
  • Otherwise well lady.

Discussion

  • Elective surgery timing after CVA
    • Consensus guidelines suggest 9/12 delay after stroke before elective surgery as this is when the nadir is reached for risk of perioperative stroke.
    • Lifetime risk remains elevated compared to someone who has not had a previous stroke
    • Most data derived from ischaemic strokes, not haemorrhagic or cardioembolic.
    • NeuroSx registrar said it would be their routine practice to perform cranioplasty asap, as the brain is unprotected from external trauma and cranioplasty may also lead to acceleration in recovery of residual stroke symptoms (thought to be due to improved CBF and CSF flow dynamics https://thejns.org/view/journals/j-neurosurg/128/1/article-p229.xml)
  • Recent steroid injection for shoulder bursitis; potential infection risk with planned prosthesis
    • NeuroSx registrar unconcerned.
    • Noted that other surgical specialities may have different views. Many orthopaedic surgeons will not accept a depot steroid injection within 3/12 of arthroplasty. 
    • Consult with surgical team if any doubts for similar cases in future.

Plan

  • Proceed with OT.