Division of Neurosurgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
Division of Neurosurgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
Childs Nerv Syst. 2021 Feb;37(2):475-479. doi: 10.1007/s00381-020-04818-w. Epub 2020 Jul 20.
Optimal management of the bone flap after craniotomy for intracranial infection has not been well defined in the pediatric population. This study reviewed the outcomes of a single Canadian center where immediate replacement of the bone flap was standard practice.
This is a retrospective study of all patients who underwent craniotomies for evacuation of epidural or subdural empyema at a single center from 1982 to 2018. Patients were identified using the prospective surgical database maintained by the Division of Pediatric Neurosurgery at BC Children's Hospital. Primary outcome was treatment failure, defined as reoperation at the site of initial surgery for removal of an infected bone flap or repeat drainage of empyema under the replaced bone flap. Secondary outcome was any reoperation for recurrent infection at any site.
Twenty-four patients met the inclusion criteria with a minimum of 3-month follow-up from the index intervention. Treatment failure occurred in four patients (17%), all of whom required repeat surgery for further drainage of pus underlying the bone flap. Mean time to repeat surgery was 13 days. Any reoperation for recurrent infection at any site occurred in three patients. Seven out of 24 patients required a second surgery to evacuate empyema (29.2%). Age, sex, epidural or subdural location, osteomyelitis, and bone flap wash were not associated with the primary outcome of treatment failure.
Immediate replacement of the bone flap in the surgical management of pediatric subdural or epidural empyema is reasonable. Replacing the flap at the time of first surgery avoids the morbidity and costs of a subsequent reconstructive operation.
对于颅内感染患者的开颅术后骨瓣的最佳处理方法在儿科人群中尚未得到很好的定义。本研究回顾了加拿大一家单中心的结果，该中心的标准做法是立即更换骨瓣。
这是一项对 1982 年至 2018 年期间在一家中心接受开颅术以清除硬膜外或硬膜下积脓的所有患者的回顾性研究。通过不列颠哥伦比亚儿童医院小儿神经外科分部维护的前瞻性手术数据库识别患者。主要结局是治疗失败，定义为最初手术部位的感染性骨瓣再次手术或更换的骨瓣下再次引流积脓。次要结局是任何部位的复发性感染的任何再手术。
24 名患者符合纳入标准，从指数干预后至少有 3 个月的随访。4 名患者（17%）发生治疗失败，均需要再次手术以进一步引流骨瓣下的脓液。再次手术的平均时间为 13 天。任何部位的复发性感染的任何再手术均发生在 3 名患者中。24 名患者中有 7 名（29.2%）需要第二次手术以排空积脓。年龄、性别、硬膜外或硬膜下位置、骨髓炎和骨瓣冲洗均与治疗失败的主要结局无关。
在小儿硬膜下或硬膜外积脓的手术治疗中，立即更换骨瓣是合理的。在初次手术时更换皮瓣可避免随后重建手术的发病率和费用。
