Korhonen Tommi K, Tetri Sami, Huttunen Jukka, Lindgren Antti, Piitulainen Jaakko M, Serlo Willy, Vallittu Pekka K, Posti Jussi P
1Department of Neurosurgery, Oulu University Hospital, Oulu.
2Research Unit of Clinical Neuroscience, Neurosurgery, Oulu University Hospital and University of Oulu.
J Neurosurg. 2018 May 11;130(5):1672-1679. doi: 10.3171/2017.12.JNS172013. Print 2019 May 1.
Craniectomy is a common neurosurgical procedure that reduces intracranial pressure, but survival necessitates cranioplasty at a later stage, after recovery from the primary insult. Complications such as infection and resorption of the autologous bone flap are common. The risk factors for complications and subsequent bone flap removal are unclear. The aim of this multicenter, retrospective study was to evaluate the factors affecting the outcome of primary autologous cranioplasty, with special emphasis on bone flap resorption.
The authors identified all patients who underwent primary autologous cranioplasty at 3 tertiary-level university hospitals between 2002 and 2015. Patients underwent follow-up until bone flap removal, death, or December 31, 2015.
The cohort comprised 207 patients with a mean follow-up period of 3.7 years (SD 2.7 years). The overall complication rate was 39.6% (82/207), the bone flap removal rate was 19.3% (40/207), and 11 patients (5.3%) died during the follow-up period. Smoking (OR 3.23, 95% CI 1.50-6.95; p = 0.003) and age younger than 45 years (OR 2.29, 95% CI 1.07-4.89; p = 0.032) were found to independently predict subsequent autograft removal, while age younger than 30 years was found to independently predict clinically relevant bone flap resorption (OR 4.59, 95% CI 1.15-18.34; p = 0.03). The interval between craniectomy and cranioplasty was not found to predict either bone flap removal or resorption.
In this large, multicenter cohort of patients with autologous cranioplasty, smoking and younger age predicted complications leading to bone flap removal. Very young age predicted bone flap resorption. The authors recommend that physicians extensively inform their patients of the pronounced risks of smoking before cranioplasty.
颅骨切除术是一种常见的神经外科手术，可降低颅内压，但患者存活下来后，在从原发性损伤恢复后，后期需要进行颅骨修补术。感染和自体骨瓣吸收等并发症很常见。并发症及随后骨瓣移除的危险因素尚不清楚。这项多中心回顾性研究的目的是评估影响原发性自体颅骨修补术结果的因素，特别关注骨瓣吸收情况。
作者确定了2002年至2015年间在3家三级大学医院接受原发性自体颅骨修补术的所有患者。对患者进行随访，直至骨瓣移除、死亡或2015年12月31日。
该队列包括207例患者，平均随访期为3.7年（标准差2.7年）。总体并发症发生率为39.6%（82/207），骨瓣移除率为19.3%（40/207），11例患者（5.3%）在随访期间死亡。发现吸烟（比值比3.23，95%置信区间1.50 - 6.95；p = 0.003）和年龄小于45岁（比值比2.29，95%置信区间1.07 - 4.89；p = 0.032）可独立预测随后的自体骨移植移除，而年龄小于30岁可独立预测具有临床意义的骨瓣吸收（比值比4.59，95%置信区间1.15 - 18.34；p = 0.03）。未发现颅骨切除与颅骨修补之间的间隔时间可预测骨瓣移除或吸收情况。
在这个大型多中心自体颅骨修补术患者队列中，吸烟和年轻年龄可预测导致骨瓣移除的并发症。非常年轻的年龄可预测骨瓣吸收。作者建议医生在颅骨修补术前应充分告知患者吸烟的显著风险。
