Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
World Neurosurg. 2021 Apr;148:e508-e517. doi: 10.1016/j.wneu.2021.01.013. Epub 2021 Jan 11.
Decompressive craniectomy (DC) relieves intracranial hypertension after severe traumatic brain injury (TBI), but it has been associated with poor clinical outcome in 2 recent randomized controlled trials. In this study, we investigated the incidence and explanatory variables for DC-related and cranioplasty (CP)-related complications after TBI.
In this retrospective study, we identified 61 patients with TBI who were treated with DC in the neurointensive care unit, Uppsala University Hospital, Sweden, between 2008 and 2018. Demography, admission status, radiology, and clinical outcome were analyzed.
Eleven patients (18%) were reoperated because of postoperative hemorrhage after DC. Six (10%) developed postoperative infection during neurointensive care. Twenty-eight (46%) developed subdural hygromas and 10 (16%) received a permanent cerebrospinal fluid shunt. Sixteen patients (26%) died before CP. Median time to CP was 7 months (range, 2-19 months) and 32 (71%) were operated on with autologous bone and 13 (29%) with synthetic material primarily. In 9 patients with autologous bone (29%), the CP had to be replaced because of bone resorption/infection, whereas this did not occur after synthetic material (P = 0.04). However, all 4 postoperative hemorrhages after CP occurred when synthetic material was used (P = 0.005).
DC and CP surgery have a high risk for complications, leading to additional neurosurgery in about one third of cases. Synthetic CP materials may decrease the risk of reoperation, but special care with hemostasis is required because of increased risk of postoperative hemorrhage. Future trials need to address these topics to further improve the outcome for these patients.
去骨瓣减压术（DC）可缓解严重创伤性脑损伤（TBI）后的颅内高压，但最近两项随机对照试验表明其与临床预后不良有关。本研究旨在探讨 TBI 后 DC 相关和颅骨修补术（CP）相关并发症的发生率及相关解释变量。
在这项回顾性研究中，我们确定了瑞典乌普萨拉大学医院神经重症监护病房 2008 年至 2018 年间接受 DC 治疗的 61 例 TBI 患者。分析了人口统计学、入院状态、影像学和临床结局。
11 例患者（18%）因 DC 术后出血而再次手术。6 例（10%）在神经重症监护期间发生术后感染。28 例（46%）出现硬膜下积液，10 例（16%）接受永久性脑脊液分流。16 例患者（26%）在 CP 前死亡。CP 的中位时间为 7 个月（范围 2-19 个月），32 例（71%）采用自体骨，13 例（29%）采用合成材料进行初次手术。在 9 例使用自体骨的患者（29%）中，CP 因骨质吸收/感染而需要更换，而使用合成材料时则不会发生这种情况（P=0.04）。然而，所有 4 例 CP 术后出血均发生在使用合成材料时（P=0.005）。
DC 和 CP 手术并发症风险较高，约三分之一的病例需要再次进行神经外科手术。合成 CP 材料可能降低再次手术的风险，但由于术后出血风险增加，需要特别注意止血。未来的试验需要解决这些问题，以进一步改善这些患者的预后。
