Quah Boon Leong, Low Hu Liang, Wilson Mark H, Bimpis Alexios, Nga Vincent D W, Lwin Sein, Zainuddin Noor Hazlina, Wahab Nasser Abd, Salek Md Al Amin
Essex Neuroscience Centre, Department of Neurosurgery, Queen's Hospital, Romford, Essex, United Kingdom; Division of Neurosurgery, Department of General Surgery, Khoo Teck Puat Hospital, Singapore.
Essex Neuroscience Centre, Department of Neurosurgery, Queen's Hospital, Romford, Essex, United Kingdom.
World Neurosurg. 2016 Oct;94:13-17. doi: 10.1016/j.wneu.2016.06.081. Epub 2016 Jun 28.
The optimal timing of cranioplasty remains uncertain.
We hypothesized that the risk of infections after primary cranioplasty in adult patients who underwent craniectomies for non-infection-related indications are no different when performed early or delayed. We tested this hypothesis in a prospective, multicenter, cohort study.
Data were collected prospectively from 5 neurosurgical centers in the United Kingdom, Malaysia, Singapore, and Bangladesh. Only patients older than 16 years from the time of the non-infection-related craniectomy were included. The recruitment period was over 17 months, and postoperative follow-up was at least 6 months. Patient baseline characteristics, rate of infections, and incidence of hydrocephalus were collected.
Seventy patients were included in this study. There were 25 patients in the early cranioplasty cohort (cranioplasty performed before 12 weeks) and 45 patients in the late cranioplasty cohort (cranioplasty performed after 12 weeks). The follow-up period ranged between 16 and 34 months (mean, 23 months). Baseline characteristics were largely similar but differed only in prophylactic antibiotics received (P = 0.28), and primary surgeon performing cranioplasty (P = 0.15). There were no infections in the early cranioplasty cohort, whereas 3 infections were recorded in the late cohort. This did not reach statistical significance (P = 0.55).
Early cranioplasty in non-infection-related craniectomy is relatively safe. There does not appear to be an added advantage to delaying cranioplasties more than 12 weeks after the initial craniectomy in terms of infection reduction. There was no significant difference in infection rates or risk of hydrocephalus between the early and late cohorts.
颅骨修补术的最佳时机仍不确定。
我们假设，因非感染相关指征行颅骨切除术的成年患者，早期或延迟进行初次颅骨修补术后的感染风险没有差异。我们在一项前瞻性、多中心队列研究中检验了这一假设。
前瞻性收集来自英国、马来西亚、新加坡和孟加拉国5个神经外科中心的数据。仅纳入非感染相关颅骨切除术后年龄大于16岁的患者。招募期超过17个月，术后随访至少6个月。收集患者基线特征、感染率和脑积水发生率。
本研究纳入70例患者。早期颅骨修补术队列中有25例患者（颅骨修补术在12周前进行），晚期颅骨修补术队列中有45例患者（颅骨修补术在12周后进行）。随访期为16至34个月（平均23个月）。基线特征大体相似，仅在接受预防性抗生素治疗方面存在差异（P = 0.28），以及进行颅骨修补术的主刀医生方面存在差异（P = 0.15）。早期颅骨修补术队列中无感染病例，而晚期队列中有3例感染记录。这未达到统计学显著性（P = 0.55）。
非感染相关颅骨切除术后早期进行颅骨修补术相对安全。在减少感染方面，初次颅骨切除术后延迟超过12周进行颅骨修补术似乎没有额外优势。早期和晚期队列之间的感染率或脑积水风险没有显著差异。
