Tora Muhibullah S, Malcolm James G, Mahmooth Zayan, Pujari Amit, Rindler Rima S, Boulis Nicholas M, Pradilla Gustavo, Grossberg Jonathan A, Ahmad Faiz U
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.
Oper Neurosurg. 2021 Mar 15;20(4):389-396. doi: 10.1093/ons/opaa408.
Cranioplasty (CP) following decompressive craniectomy (DC) is a common neurosurgical procedure for cranial cosmesis and protection. There is uncertainty regarding the complication rates and potential benefits related to the timing of CP.
To investigate the impact of the timing of CP on complication rates for different etiologies of DC.
A retrospective chart review was performed of all CP cases between 2004 and 2018 for traumatic and nontraumatic indications of DC. Demographics, clinical characteristics, and complications were collected. Early and late CP were defined as replacement of the bone flap at ≤90 and >90 d following DC, respectively.
A total of 278 patients were included, receiving 81 early and 197 late CPs. When analyzing all patients, early CP was associated with a statistically significant higher odds of any complication (odds ratio [OR]: 3.25, P < .001), reoperation (OR: 2.57, P = .019), hydrocephalus (OR: 6.03, P = .003), and symptomatic extra-axial collections (OR: 9.22, P = .003). Subgroup analysis demonstrated statistically significant higher odds of these complications only for the CP trauma subgroup, but not the nontrauma subgroup. The odds of complications postCP demonstrated a statistically significant decrease of 4.4% for each week after DC (Unit Odds Ratio [U-OR]: 0.956, P = .0363).
In our retrospective series, early CP was associated with higher odds of postoperative complications compared to late CP in the trauma subgroup. Greater care should be taken in preoperative planning and increased vigilance postoperatively for complications with this potentially more vulnerable subpopulation. Future prospective controlled trials are needed to elucidate optimal timing for CP.
减压性颅骨切除术后的颅骨成形术是一种常见的神经外科手术，用于颅骨美容和保护。关于颅骨成形术的时机与并发症发生率及潜在益处存在不确定性。
研究颅骨成形术时机对不同病因减压性颅骨切除术并发症发生率的影响。
对2004年至2018年间所有因创伤性和非创伤性减压性颅骨切除术而行颅骨成形术的病例进行回顾性图表审查。收集人口统计学、临床特征和并发症情况。早期和晚期颅骨成形术分别定义为在减压性颅骨切除术后≤90天和>90天进行骨瓣置换。
共纳入278例患者，其中81例接受早期颅骨成形术，197例接受晚期颅骨成形术。在分析所有患者时，早期颅骨成形术与任何并发症（优势比[OR]：3.25，P<.001）、再次手术（OR：2.57，P=.019）、脑积水（OR：6.03，P=.003）和有症状的轴外积液（OR：9.22，P=.003）的统计学显著更高优势相关。亚组分析表明，仅在颅骨成形术创伤亚组中这些并发症的优势有统计学显著升高，而非创伤亚组则不然。颅骨成形术后并发症的优势在减压性颅骨切除术后每周有统计学显著下降4.4%（单位优势比[U-OR]：0.956，P=.0363）。
在我们的回顾性系列研究中，与创伤亚组中的晚期颅骨成形术相比，早期颅骨成形术与术后并发症的更高优势相关。对于这个潜在更脆弱的亚组，术前规划应更加谨慎，术后对并发症应提高警惕。需要未来的前瞻性对照试验来阐明颅骨成形术的最佳时机。
