Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Neurosurg Rev. 2021 Jun;44(3):1755-1763. doi: 10.1007/s10143-020-01374-4. Epub 2020 Aug 26.
Cranioplasty (CP) is a standard procedure in neurosurgical practice for patients after (decompressive) craniectomy. However, CP surgery is not standardized, is carried out in different ways, and is associated with considerable complication rates. Here, we report our experiences with the use of different CP materials and analyze long-term complications and implant survival rates. We retrospectively studied patients who underwent CP surgery at our institution between 2004 and 2014. Binary logistic regression analysis was performed in order to identify risk factors for the development of complications. Kaplan-Meier analysis was used to estimate implant survival rates. A total of 392 patients (182 females, 210 males) with a mean age of 48 years were included. These patients underwent a total of 508 CP surgeries. The overall complication rate of primary CP was 33.2%, due to bone resorption/loosening (14.6%) and graft infection (7.9%) with a mean implant survival of 120 ± 5 months. Binary logistic regression analysis showed that young age (< 30 years) (p = 0.026, OR 3.150), the presence of multidrug-resistant bacteria (p = 0.045, OR 2.273), and cerebrospinal fluid (CSF) shunt (p = 0.001, OR 3.137) were risk factors for postoperative complications. The use of titanium miniplates for CP fixation was associated with reduced complication rates and bone flap osteolysis as well as longer implant survival rates. The present study highlights the risk profile of CP surgery. Young age (< 30 years) and shunt-dependent hydrocephalus are associated with postoperative complications especially due to bone flap autolysis. Furthermore, a rigid CP fixation seems to play a crucial role in reducing complication rates.
颅骨修补术（CP）是神经外科减压性颅骨切除术患者的标准手术。然而，CP 手术尚未标准化，其手术方式各异，且并发症发生率相当高。在此，我们报告了使用不同 CP 材料的经验，并分析了长期并发症和植入物存活率。我们回顾性研究了 2004 年至 2014 年期间在我院行 CP 手术的患者。为了确定并发症发生的风险因素，我们进行了二元逻辑回归分析。Kaplan-Meier 分析用于估计植入物存活率。共纳入 392 例患者（182 例女性，210 例男性），平均年龄为 48 岁。这些患者共行 508 例 CP 手术。初次 CP 的总体并发症发生率为 33.2%，原因是骨吸收/松动（14.6%）和移植物感染（7.9%），平均植入物存活率为 120 ± 5 个月。二元逻辑回归分析表明，年龄较小（<30 岁）（p=0.026，OR 3.150）、存在多重耐药菌（p=0.045，OR 2.273）和脑脊液（CSF）分流（p=0.001，OR 3.137）是术后并发症的危险因素。CP 固定中使用钛小板与降低并发症发生率和颅骨瓣骨溶解以及延长植入物存活率有关。本研究强调了 CP 手术的风险概况。年轻（<30 岁）和分流依赖性脑积水与术后并发症有关，尤其是颅骨瓣自溶。此外，刚性 CP 固定似乎在降低并发症发生率方面发挥着至关重要的作用。
