Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
J Neurosurg. 2011 Apr;114(4):954-60. doi: 10.3171/2009.12.JNS091065. Epub 2010 Jan 29.
The object of this study was to describe the rapid closure technique in decompressive craniectomy without duraplasty and its use in a large cohort of consecutive patients.
Between 1999 and 2008, supratentorial rapid closure decompressive craniectomy (RCDC) was performed 341 times in 318 patients at the authors' institution. Cases were stratified as 1) traumatic brain injury, 2) subarachnoid hemorrhage, 3) intracerebral hemorrhage, 4) cerebral infarction, and 5) other. A large bone flap was removed and the dura mater was opened in a stellate fashion. Duraplasty was not performed-that is, the dura was not sutured, and a dural substitute was neither sutured in nor layed on. The dura and exposed brain tissue were covered with hemostyptic material (Surgicel). Surgical time and complications of this procedure including follow-up (> 6 months) were recorded. After 3-6 months cranioplasty was performed, and, again, surgical time and any complications were recorded.
Rapid closure decompressive craniectomy was feasible in all cases. Complications included superficial wound healing disturbance (3.5% of procedures), abscess (2.6%) and CSF fistula (0.6%); the mean surgical time (± SD) was 69 ± 20 minutes. Cranioplasty was performed in 196 cases; the mean interval (± SD) from craniectomy to cranioplasty was 118 ± 40 days. Complications of cranioplasty included epidural hematoma (4.1%), abscess (2.6%), wound healing disturbance (6.1%), and CSF fistula (1%). Compared with the results reported in the literature for decompressive craniectomy with duraplasty followed by cranioplasty, there were no significant differences in the frequency of complications. However, surgical time for RCDC was significantly shorter (69 ± 20 vs 129 ± 43 minutes, p < 0.0001).
The present analysis of the largest series reported to date reveals that the rapid closure technique is feasible and safe in decompressive craniectomy. The surgical time is significantly shorter without increased complication rates or additional complications. Cranioplasty after a RCDC procedure was also feasible, fast, safe and not impaired by the RCDC technique.
本研究旨在描述去骨瓣减压术中不进行硬脑膜修补的快速关颅技术，并将其应用于大量连续患者。
1999 年至 2008 年，作者所在机构对 318 例患者的 341 例进行了幕上快速关颅减压术（RCDC）。病例分为 1）创伤性脑损伤，2）蛛网膜下腔出血，3）脑出血，4）脑梗死和 5）其他。大骨瓣切除，硬脑膜呈星状切开。未进行硬脑膜成形术，即硬脑膜未缝合，也未缝合或放置硬脑膜替代品。硬脑膜和暴露的脑组织用止血材料（Surgicel）覆盖。记录该手术的手术时间和包括随访（>6 个月）在内的并发症。3-6 个月后行颅骨成形术，并再次记录手术时间和任何并发症。
所有病例均可行快速关颅减压术。并发症包括浅表伤口愈合障碍（3.5%的手术）、脓肿（2.6%）和 CSF 瘘（0.6%）；平均手术时间（±SD）为 69±20 分钟。196 例行颅骨成形术；颅骨切除术与颅骨成形术之间的平均间隔（±SD）为 118±40 天。颅骨成形术的并发症包括硬膜外血肿（4.1%）、脓肿（2.6%）、伤口愈合障碍（6.1%）和 CSF 瘘（1%）。与文献中报道的硬脑膜修补术后行减压性颅骨切除术的结果相比，并发症的发生率无显著差异。然而，RCDC 的手术时间明显缩短（69±20 与 129±43 分钟，p<0.0001）。
目前对迄今为止报道的最大系列的分析表明，快速关颅技术在去骨瓣减压术中是可行且安全的。手术时间明显缩短，并发症发生率或额外并发症无增加。RCDC 术后行颅骨成形术也是可行的、快速的、安全的，并且不会因 RCDC 技术而受到影响。
