Zhu Sihan, Chen Yinsheng, Lin Fuhua, Chen Zhenghe, Jiang Xiaobing, Zhang Ji, Wang Jian
Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China.
Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China.
J Clin Neurosci. 2021 Feb;84:66-74. doi: 10.1016/j.jocn.2020.12.009. Epub 2020 Dec 28.
Decompressive craniectomy is widely used to treat medically refractory intracranial hypertension. There were still few studies focusing on the complications between titanium cranioplasty with non-titanium materials cranioplasty. Our systematic review and meta-analysis aimed to assess the complications following titanium cranioplasty and to make a comparison with nontitanium materials. A systematic review was used to review titanium cranioplasty characters in recent articles. A systematic literature review and meta-analysis were performed by using PubMed/MEDLINE, Scopus, the Cochrane databases and Embase for studies reporting on cranioplasty procedures that compared complication outcomes between titanium with non-titanium materials. The final 15 studies met inclusion criteria and represented 2258 cranioplasty procedures (896 titanium, 1362 nontitanium materials). Overall complications included surgical site infection, hematoma, implant exposure, seizure, cerebrospinal fluid leak, imprecise fitting. Titanium cranioplasty was associated with a significant decrease in overall complications rate (OR, 0.72; P = 0.007), hematoma rate (OR, 0.31; P = 0.0003) and imprecise fitting rate (OR, 0.35; P = 0.04). However, it also suggested that titanium cranioplasty can be greatly increased implant exposure rate (OR, 4.11; P < 0.00001). Our results confirmed the advantages of titanium cranioplasty in reducing complications including hematoma, imprecise fitting, and also suggested that clinicians should pay more attention to postoperative implant exposure. With new synthetic materials emerging, it would also be interesting to study the cost-effect and functional outcomes associated with cranioplasty materials.
减压性颅骨切除术被广泛用于治疗内科治疗无效的颅内高压。目前针对钛质颅骨修补术与非钛质材料颅骨修补术并发症的研究仍较少。我们的系统评价和荟萃分析旨在评估钛质颅骨修补术后的并发症，并与非钛质材料进行比较。采用系统评价来回顾近期文章中钛质颅骨修补术的特点。通过使用PubMed/MEDLINE、Scopus、Cochrane数据库和Embase进行系统的文献回顾和荟萃分析，以检索报告颅骨修补术程序并比较钛质与非钛质材料并发症结果的研究。最终有15项研究符合纳入标准，共涉及2258例颅骨修补术（896例钛质修补，1362例非钛质材料修补）。总体并发症包括手术部位感染、血肿、植入物外露、癫痫发作、脑脊液漏、贴合不精确。钛质颅骨修补术的总体并发症发生率（OR，0.72；P = 0.007）、血肿发生率（OR，0.31；P = 0.0003）和贴合不精确发生率（OR，0.35；P = 0.04）显著降低。然而，研究也提示钛质颅骨修补术会大幅增加植入物外露率（OR，4.11；P < 0.00001）。我们的结果证实了钛质颅骨修补术在减少包括血肿、贴合不精确等并发症方面的优势，同时也提示临床医生应更加关注术后植入物外露情况。随着新型合成材料的出现，研究颅骨修补材料的成本效益和功能结局也将很有意义。
