Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
World Neurosurg. 2016 Aug;92:83-88. doi: 10.1016/j.wneu.2016.04.113. Epub 2016 May 6.
Previous clinical studies assumed that early cranioplasty (CP) was mandatory for a favorable neurologic recovery after decompressive craniectomy (DC) for malignant stroke. However, the appropriate timing of the CP procedure after DC remains controversial. This study assessed patients who underwent DC because of cerebral ischemia to determine the appropriate time point of CP and surgical-associated complications.
Data from the period 2007-2014 were retrospectively evaluated. CP was performed in 75 patients who previously underwent DC because of supratentorial cerebral infarction. Patients were divided into 2 groups (early CP vs. late CP) according to the time from DC to CP (<3 months vs. ≥3 months). Patient characteristics, timing of CP, and postoperative complications associated with CP were analyzed.
CP was performed early in 12 patients (16%) and late in 63 patients (84%). The complication rate after CP was 18%; complications included wound healing disturbance in 8 patients (11%), epidural hematoma or subdural hematoma in 4 patients (4%), and others in 2 patients (3%). Patients with early CP experienced significantly more complications compared with patients with late CP after initial DC (5 of 12 patients [42%] vs. 8 of 63 patients [13%]; P = 0.02). In multivariate analysis, early CP was a significant predictor of postoperative complications after CP (odds ratio = 6.04; 95% confidence interval, 1.4-24.9; P = 0.01).
The present data suggest that patients who underwent DC for stroke might benefit from CP performed >3 months after DC owing to a lower rate of wound infection.
先前的临床研究假设，在减压性颅骨切开术后（DC）进行早期颅骨修补术（CP）对于恶性中风的神经功能恢复是必要的。然而，DC 后 CP 手术的适当时机仍存在争议。本研究评估了因脑缺血而行 DC 的患者，以确定 CP 的适当时间点和手术相关并发症。
回顾性评估了 2007 年至 2014 年期间的数据。75 例因大脑半球梗死而行 DC 的患者随后接受了 CP。根据 DC 至 CP 的时间（<3 个月 vs. ≥3 个月），患者分为 2 组（早期 CP 与晚期 CP）。分析了患者特征、CP 的时间以及与 CP 相关的术后并发症。
12 例（16%）患者行早期 CP，63 例（84%）患者行晚期 CP。CP 后并发症发生率为 18%；并发症包括 8 例（11%）患者的伤口愈合障碍、4 例（4%）患者的硬膜外血肿或硬膜下血肿以及 2 例（3%）患者的其他并发症。与初次 DC 后行晚期 CP 的患者相比，早期 CP 的患者 CP 后并发症明显更多（12 例患者中有 5 例[42%] vs. 63 例患者中有 8 例[13%]；P=0.02）。多变量分析显示，早期 CP 是 CP 后术后并发症的显著预测因素（比值比=6.04；95%置信区间，1.4-24.9；P=0.01）。
本研究数据表明，因中风而行 DC 的患者可能受益于 DC 后>3 个月进行 CP，因为感染性并发症的发生率较低。
