Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
World Neurosurg. 2019 Dec;132:e479-e486. doi: 10.1016/j.wneu.2019.08.106. Epub 2019 Aug 26.
Management of pediatric skull defects after decompressive craniectomy (DC) poses unique problems, particularly in children younger than 24 months. These problems include complications such as resorption and infection as well as difficulties with plagiocephaly and reconstruction. The goal of this study was to evaluate bone resorption complications after cranioplasty in patients <24 months.
A single-center retrospective case study was performed of all patients younger than 24 months who underwent cranioplasty after DC between 2011 and 2018. The following variables were assessed: injury cause, age at craniotomy, time to cranioplasty, craniectomy size, mode of fixation, drain use, shunt use, subdural fluid collection, resorption, need for synthetic graft revision, and plagiocephaly.
A total of 10 patients were identified who met inclusion criteria; 3 patients were excluded for insufficient follow-up. Ages ranged from <1 day to 19 months, with a mean of 10.7 months. Overall rate of cranioplasty resorption was 85.7%, 57.1% of which required revision with synthetic graft. There were univariate trends toward more frequent implant resorption with subdural fluid collection (P = 0.1071) and without shunt placement (P = 0.1429). These effects persisted through multivariable analysis and even reached statistical significance in the case of subdural collection when controlling for operative and demographic characteristics (P = 0.01138, P = 0.0694). In addition, univariate analysis showed a trend toward more frequent neurologic complications with greater craniotomy-to-cranioplasty intervals (P = 0.1043), which reached significance on multivariable analysis (P = 0.00518).
In patients younger than 24 months undergoing cranioplasty subdural collection, a lack of shunt placement and increased time to cranioplasty were associated with increased rates of resorption.
去骨瓣减压术后（DC）儿童颅骨缺损的管理存在独特的问题，尤其是 24 个月以下的儿童。这些问题包括吸收和感染等并发症，以及斜头畸形和重建的困难。本研究的目的是评估 24 个月以下患者颅骨成形术后骨吸收并发症。
对 2011 年至 2018 年期间因 DC 后行颅骨成形术的所有 24 个月以下患者进行单中心回顾性病例研究。评估以下变量：损伤原因、开颅年龄、颅骨成形术时间、颅骨切除术大小、固定方式、引流管使用、分流管使用、硬膜下积液、吸收、需要合成移植物修复以及斜头畸形。
共确定 10 例符合纳入标准的患者；3 例因随访时间不足而被排除。年龄从<1 天至 19 个月不等，平均年龄为 10.7 个月。颅骨成形术吸收的总体发生率为 85.7%，其中 57.1%需要用合成移植物进行修复。有单变量趋势表明，硬膜下积液（P=0.1071）和无分流管放置（P=0.1429）与更频繁的植入物吸收相关。这些影响通过多变量分析仍然存在，甚至在控制手术和人口统计学特征后，硬膜下积液的情况下达到统计学意义（P=0.01138，P=0.0694）。此外，单变量分析显示，颅骨切除术到颅骨成形术的时间间隔较长与更频繁的神经并发症有单变量趋势（P=0.1043），多变量分析显示差异具有统计学意义（P=0.00518）。
在 24 个月以下行颅骨成形术的患者中，硬膜下积液、无分流管放置和颅骨成形术时间延长与吸收率增加相关。
