Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan 48202, USA.
J Neurosurg. 2010 May;112(5):1120-4. doi: 10.3171/2009.6.JNS09133.
Hemicraniectomy is a commonly practiced neurosurgical intervention with a wide range of indications and clinical data supporting its use. The extensive use of this procedure directly results in more cranioplasties to repair skull defects. The complication rate for cranial repair after craniectomy seems to be higher than that of the typical elective craniotomy. This finding prompted the authors to review their experience with patients undergoing cranial repair.
The authors performed a retrospective review of 212 patients who underwent cranial repair over a 13-year period at their institution. A database tracking age, presenting diagnosis, side of surgery, length of time before cranial repair, bone graft material used, presence of a ventricular shunt, presence of a postoperative drain, and complications was created and analyzed.
The overall complication rate was 16.4% (35 of 213 patients). Patients 0-39 years of age had the lowest complication rate of 8% (p = 0.028). For patients 40-59 years of age and older than 60, complication rates were 20 and 26%, respectively. Patients who originally presented with traumatic injuries had a lower rate of complications than those who did not (10 vs 20%; p = 0.049). Conversely, patients who presented with tumors had a higher complication rate than those without (38 vs 15%; p = 0.027). Patients who received autologous bone graft placement had a statistically significant lower risk of postoperative infection (4.6 vs 18.4%; p = 0.002). Patients who underwent cranioplasty with a 0-3 month interval between operations had a complication rate of 9%, 3-6 months 18.8%, and > 6 months 26%. Pairwise comparisons showed that the difference between the 0-3 month interval and the > 6-month interval was significant (p = 0.007). The difference between the 0-3 month interval and the 4-6 month interval showed a trend (p = 0.07). No difference was detected between the 4-6 month interval and > 6-month interval (p = 0.35).
The overall rate of complications related to cranioplasty after craniectomy is not negligible, and certain factors may be associated with increased risk. Therefore, when evaluating the need to perform a large decompressive craniectomy, the surgeon should also be aware that the patient is not only subject to the risks of the initial operation, but also the risks of subsequent cranioplasty.
去骨瓣减压术是一种广泛应用的神经外科干预手段，其适应证广泛，临床数据支持其应用。该手术的广泛应用直接导致了更多的颅骨修复手术来修复颅骨缺损。颅骨切除术后颅骨修复的并发症发生率似乎高于典型的择期开颅手术。这一发现促使作者回顾他们在机构中进行颅骨修复的经验。
作者对 13 年间在他们的机构接受颅骨修复的 212 名患者进行了回顾性研究。创建并分析了一个跟踪患者年龄、就诊诊断、手术侧、颅骨修复前时间、使用的骨移植物材料、是否存在脑室分流管、是否存在术后引流管以及并发症的数据库。
总体并发症发生率为 16.4%（213 例患者中有 35 例）。0-39 岁的患者并发症发生率最低，为 8%（p=0.028）。40-59 岁和 60 岁以上的患者的并发症发生率分别为 20%和 26%。最初因创伤而就诊的患者并发症发生率低于未因创伤而就诊的患者（10%比 20%；p=0.049）。相反，因肿瘤就诊的患者并发症发生率高于未因肿瘤就诊的患者（38%比 15%；p=0.027）。接受自体骨移植的患者术后感染的风险显著降低（4.6%比 18.4%；p=0.002）。手术间隔 0-3 个月的患者并发症发生率为 9%，3-6 个月的患者并发症发生率为 18.8%，>6 个月的患者并发症发生率为 26%。两两比较显示，0-3 个月间隔与>6 个月间隔之间的差异具有统计学意义（p=0.007）。0-3 个月间隔与 4-6 个月间隔之间的差异呈趋势（p=0.07）。4-6 个月间隔与>6 个月间隔之间无差异（p=0.35）。
去骨瓣减压术后颅骨修复相关并发症的总体发生率不容忽视，某些因素可能与风险增加相关。因此，在评估是否需要进行大骨瓣减压术时，外科医生还应意识到，患者不仅面临初始手术的风险，还面临后续颅骨修复的风险。
