Complication rates after autologous cranioplasty following decompressive craniectomy

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2024-09-25 DOI:10.1007/s00701-024-06282-w

Leonard Ritter, Kilian Strohhäcker, Karl-Michael Schebesch, Thomas Eibl, Julius Höhne, Adrian Liebert

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引用次数: 0

Abstract

Objective

The reimplantation of autologous bone grafts after decompressive craniectomy (DC) is still up for debate. The objective of this study was to analyze the surgical revision rate for autologous cranioplasties in our center, aiming to identify predictors for procedure-related-complications.

Methods

A retrospective single-center study was conducted for adult patients who underwent autologous cranioplasty after DC. The primary endpoint was the complication rate in terms of surgical revision and removal of the bone graft: infection, new onset seizures, dislocation, haemorrhage, osteolysis, wound dehiscence and cerebrospinal fluid (CSF) fistula. Demographic data, medical records, surgical reports and imaging studies were analysed and risk factors for complications were evaluated.

Results

169 consecutive patients were included. The median interval between DC and cranioplasty was 84 days. Mean age was 51 ± 12.4 years. 26 patients (15.3%) had revision surgery for following reasons. n = 9 implant dislocations (5.3%), n = 7 osteolysis (3.6%), n = 6 infections (3.6%), n = 5 had re-bleedings (3%), n = 5 wound dehiscences (3%), and n = 2 CSF fistulas (1.2%). 18 patients developed new seizures (10.7%). Bi- and multivariate analysis revealed three independent risk factors, simultaneous ventriculo-peritoneal (VP) shunting increased the risk for material dislocation (p < 0.001); large bone grafts (> 193.5 cm²) increased the risk for osteolysis (p = 0.001) and bifrontal cranioplasties were associated with higher risk for infections (p = 0.04).

Conclusion

The complication rates in our study were comparable to previously reported data for autologous or artificial cranioplasties. As osteolysis was correlated to larger bone grafts, a synthetic alternative should be considered in selected cases.

查看原文本刊更多论文

颅骨减压切除术后自体颅骨成形术的并发症发生率。

目的：减压颅骨切除术（DC）后自体骨移植的再植仍有争议。本研究的目的是分析本中心自体颅骨成形术的手术翻修率，旨在确定手术相关并发症的预测因素：方法：对接受 DC 后自体颅骨成形术的成年患者进行了一项回顾性单中心研究。主要终点是手术翻修和移除植骨的并发症发生率：感染、新发癫痫、脱位、出血、骨溶解、伤口裂开和脑脊液（CSF）瘘。对人口统计学数据、病历、手术报告和影像学检查进行了分析，并对并发症的风险因素进行了评估：结果：共纳入 169 名连续患者。直肠指诊与颅骨成形术之间的中位间隔为 84 天。平均年龄为 51 ± 12.4 岁。26 名患者（15.3%）因以下原因接受了翻修手术：9 例植入物脱位（5.3%），7 例骨溶解（3.6%），6 例感染（3.6%），5 例再次出血（3%），5 例伤口裂开（3%），2 例 CSF 管瘘管（1.2%）。18 名患者出现新的癫痫发作（10.7%）。双变量和多变量分析显示了三个独立的风险因素：同时进行脑室-腹膜（VP）分流增加了材料脱位的风险（p 193.5 cm2），增加了骨溶解的风险（p = 0.001），双额叶颅骨成形术与较高的感染风险相关（p = 0.04）：结论：我们研究中的并发症发生率与之前报道的自体或人工颅骨成形术数据相当。由于骨溶解与较大的骨移植相关，因此在某些情况下应考虑采用人工合成替代物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.