Chaturvedi Jitender, Botta Ragasudha, Prabhuraj A R, Shukla Dhaval, Bhat Dahnanjay I, Devi B Indira
a Department of Neurosurgery , NIMHANS , Bengaluru , India.
b Department of Clinical Neurosciences , NIMHANS , Bengaluru , India.
Br J Neurosurg. 2016;30(2):264-8. doi: 10.3109/02688697.2015.1054356. Epub 2015 Jun 17.
Decompressive craniectomy (DC)--a potentially life-saving intervention following traumatic brain injury (TBI) with medically refractory brain swelling--once performed, surviving patients, more often than not, undergo a second procedure with cranioplasty (CP) in the future. This study analyzes complications following CP after DC, as the beneficial effects of the DC can't be extrapolated in long run over a population unless one adds into it the complications associated with the CP in the survivors of TBI.
An observational study was performed retrospectively, with the review of case records. Demographic, clinical, and outcome data were collected, and complications were studied for any predictive parameters. A multivariate analysis was performed to identify factors that influenced these complications.
Data were collected for a total of 74 patients who underwent CP with a median age of 32, and a mean follow-up time of 2 years and 8 months. The mortality rate was 1.35% and overall complication rate 31%. The most significant factor determining complications were operating time more than 90 min Odds ratio (OR) 4.77 (1.61-14.20); timing of CP less than 3 months after craniectomy, OR 2.86 (1.48-8.11); age more than 20 years, OR 2.59 (1.20-6.53); and female gender, OR 1.91 (1.13-4.17).
Although considered as a straight-forward procedure, the risks associated with this elective procedure should be kept in mind by the surgeon so that the patients and families can be apprised judiciously. It should be ascertained that patient and/or family consents for the procedure after being appropriately informed about the benefits and risks associated with the procedure.
减压性颅骨切除术（DC）——一种在创伤性脑损伤（TBI）后出现药物难治性脑肿胀时可能挽救生命的干预措施——一旦实施，存活患者日后往往需要接受第二次颅骨修补术（CP）。本研究分析了DC术后CP的并发症，因为除非将TBI幸存者中与CP相关的并发症考虑在内，否则DC的有益效果从长远来看无法推广至整个人群。
进行了一项回顾性观察研究，查阅病例记录。收集了人口统计学、临床和结局数据，并研究并发症的任何预测参数。进行多变量分析以确定影响这些并发症的因素。
共收集了74例行CP患者的数据，中位年龄32岁，平均随访时间2年8个月。死亡率为1.35%，总体并发症发生率为31%。决定并发症的最显著因素为手术时间超过90分钟，比值比（OR）4.77（1.61 - 14.20）；颅骨切除术后3个月内进行CP，OR 2.86（1.48 - 8.11）；年龄超过20岁，OR 2.59（1.20 - 6.53）；女性，OR 1.91（1.13 - 4.17）。
尽管该选择性手术被认为是一种简单的手术，但外科医生应牢记与该手术相关的风险，以便能够明智地告知患者及其家属。应确保患者和/或家属在充分了解该手术的益处和风险后同意进行该手术。
