1Department of Neurosurgery, RWTH Aachen University Hospital, Aachen; and.
2Department of Neurosurgery, Military Hospital Koblenz, Germany.
J Neurosurg. 2020 Apr 24;134(3):1262-1270. doi: 10.3171/2020.2.JNS193335. Print 2021 Mar 1.
Performing a cranioplasty (CP) after decompressive craniotomy is a straightforward neurosurgical procedure, but it remains associated with a high complication rate. Surgical site infection (SSI), aseptic bone resorption (aBR), and need for a secondary CP are the most common complications. This observational study aimed to identify modifiable risk factors to prevent CP failure.
A retrospective analysis was performed of all patients who underwent CP following decompressive hemicraniectomy (DHC) between 2010 and 2018 at a single institution. Predictors of SSI, aBR, and need for allograft CP were evaluated in a univariate analysis and multivariate logistic regression model.
One hundred eighty-six patients treated with CP after DHC were included. The diagnoses leading to a DHC were as follows: stroke (83 patients, 44.6%), traumatic brain injury (55 patients, 29.6%), subarachnoid hemorrhage (33 patients, 17.7%), and intracerebral hemorrhage (15 patients, 8.1%). Post-CP SSI occurred in 25 patients (13.4%), whereas aBR occurred in 32 cases (17.2%). An altered posterior question-mark incision, ending behind the ear, was associated with a significantly lower infection rate and CP failure, compared to the classic question-mark incision (6.3% vs 18.4%; p = 0.021). The only significant predictor of aBR was patient age, in which those developing resorption were on average 16 years younger than those without aBR (p < 0.001).
The primary goal of this retrospective cohort analysis was to identify adjustable risk factors to prevent post-CP complications. In this analysis, a posterior question-mark incision proved beneficial regarding infection and CP failure. The authors believe that these findings are caused by the better vascularized skin flap due to preservation of the superficial temporal artery and partial preservation of the occipital artery. In this trial, the posterior question-mark incision was identified as an easily and costless adaptable technique to reduce CP failure rates.
去骨瓣减压术后行颅骨修补术（CP）是一种简单的神经外科手术，但仍存在较高的并发症发生率。手术部位感染（SSI）、无菌性骨吸收（aBR）和需要二次 CP 是最常见的并发症。本观察性研究旨在确定可改变的风险因素以预防 CP 失败。
对 2010 年至 2018 年期间在一家机构行 CP 治疗的所有去骨瓣减压术后患者进行回顾性分析。在单变量分析和多变量逻辑回归模型中评估 SSI、aBR 和同种异体 CP 需求的预测因素。
共纳入 186 例 DHC 后行 CP 治疗的患者。导致 DHC 的诊断如下：中风（83 例，44.6%）、创伤性脑损伤（55 例，29.6%）、蛛网膜下腔出血（33 例，17.7%）和脑出血（15 例，8.1%）。25 例（13.4%）发生 CP 后 SSI，32 例（17.2%）发生 aBR。与经典问号切口相比，改变后的问号后切口（止于耳后）感染率和 CP 失败率显著降低（6.3%比 18.4%；p = 0.021）。aBR 的唯一显著预测因素是患者年龄，发生吸收的患者平均比未发生 aBR 的患者年轻 16 岁（p < 0.001）。
本回顾性队列分析的主要目的是确定可调节的风险因素以预防 CP 后并发症。在这项分析中，问号后切口在感染和 CP 失败方面显示出了益处。作者认为，这是由于保留了颞浅动脉和部分保留枕动脉导致皮瓣血管化更好所致。在这项试验中，问号后切口被认为是一种简单且经济的可调节技术，可以降低 CP 失败率。
