Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK.
Department of Rehabilitation Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB20QQ, UK.
Acta Neurochir (Wien). 2019 Mar;161(3):467-472. doi: 10.1007/s00701-019-03820-9. Epub 2019 Feb 4.
Cranioplasty is an increasingly common procedure performed in neurosurgical centres following a decompressive craniectomy (DC), however, timing of the procedure varies greatly.
The aim of this study is to compare the surgical outcomes of an early compared to a late cranioplasty procedure.
Ninety adult patients who underwent a prosthetic cranioplasty between 2014 and 2017 were studied retrospectively. Timing of operation, perioperative complications and length of stay were assessed. Early and late cranioplasties were defined as less or more than 3 months since craniectomy respectively.
Of the 90 patients, 73% received a late cranioplasty and 27% received an early cranioplasty. The median interval between craniectomy and cranioplasty was 13 months [range 3-84] in late group versus 54 days [range 33-90] in early group. Twenty-two patients in the early group (91%) received a cranioplasty during the original admission while undergoing rehabilitation. Complications were seen in 25 patients (28%). These included wound or cranioplasty infection, hydrocephalus, symptomatic pneumocephalus, post-operative haematoma and cosmetic issues. The complication rate was 21% in the early group and 30% in the late group (P value 0.46). There was no significant difference in the rate of infection or hydrocephalus between the two groups. Length of stay was not significantly increased in patients who received an early cranioplasty during their initial admission (median length of stay 77 days versus 63 days, P value 0.28).
We have demonstrated the potential for early cranioplasty to be a safe and viable option, when compared to delayed cranioplasty.
去颅骨瓣减压术后行颅骨修补术在神经外科中心越来越常见，但手术时机差异较大。
本研究旨在比较早期与晚期颅骨修补术的手术结果。
回顾性分析 2014 年至 2017 年间行颅骨修补术的 90 例成年患者。评估手术时机、围手术期并发症和住院时间。早期和晚期颅骨修补术分别定义为去颅骨瓣减压术后 3 个月内和 3 个月以上行颅骨修补术。
90 例患者中，73%行晚期颅骨修补术，27%行早期颅骨修补术。晚期组颅骨修补术与去颅骨瓣减压术的中位间隔时间为 13 个月[范围 3-84]，早期组为 54 天[范围 33-90]。早期组 22 例（91%）患者在康复期间行同期颅骨修补术。25 例（28%）患者发生并发症，包括伤口或颅骨修补感染、脑积水、症状性气颅、术后血肿和美容问题。早期组并发症发生率为 21%，晚期组为 30%（P 值 0.46）。两组感染或脑积水发生率无显著差异。早期行同期颅骨修补术的患者住院时间无显著延长（中位住院时间 77 天比 63 天，P 值 0.28）。
与晚期颅骨修补术相比，早期颅骨修补术具有安全性和可行性。
