Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 74, 27100, Pavia, Italy.
IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
Neurosurg Rev. 2021 Dec;44(6):3125-3142. doi: 10.1007/s10143-021-01511-7. Epub 2021 Mar 8.
Despite being a common procedure, cranioplasty (CP) is associated with a variety of serious, at times lethal, complications. This study explored the relationship between the initial injury leading to decompressive craniectomy (DC) and the rates and types of complications after subsequent CP. It specifically compared between traumatic brain injury (TBI) patients and patients undergoing CP after DC for other indications.A comprehensive search of PubMed, Scopus, and the Cochrane Library databases using PRISMA guidelines was performed to include case-control studies, cohorts, and clinical trials reporting complication data for CP after DC. Information about the patients' characteristics and the rates of overall and specific complications in TBI and non-TBI patients was extracted, summarized, and analyzed.A total of 59 studies, including the authors' institutional experience, encompassing 9264 patients (4671 TBI vs. 4593 non-TBI) met the inclusion criteria; this total also included 149 cases from our institutional series. The results of the analysis of the published series are shown both with and without our series 23 studies reported overall complications, 40 reported infections, 10 reported new-onset seizures, 13 reported bone flap resorption (BFR), 5 reported post-CP hydrocephalus, 10 reported intracranial hemorrhage (ICH), and 8 reported extra-axial fluid collections (EFC). TBI was associated with increased odds of BFR (odds ratio [OR] 1.76, p < 0.01) and infection (OR 1.38, p = 0.02). No difference was detected in the odds of overall complications, seizures, hydrocephalus, ICH, or EFC.Awareness of increased risks of BFR and infection after CP in TBI patients promotes the implementation of new strategies to prevent these complications especially in this category of patients.
尽管去颅骨术（CP）是一种常见的手术，但它与各种严重的并发症有关，有时甚至是致命的。本研究探讨了导致减压性颅骨切除术（DC）的初始损伤与随后 CP 后的并发症发生率和类型之间的关系。它特别比较了创伤性脑损伤（TBI）患者和因其他原因行 DC 后行 CP 的患者之间的关系。
采用 PRISMA 指南对 PubMed、Scopus 和 Cochrane 图书馆数据库进行了全面检索，纳入了报告 DC 后 CP 并发症数据的病例对照研究、队列研究和临床试验。提取、总结和分析了患者特征信息以及 TBI 和非 TBI 患者的总体和特定并发症发生率。
共有 59 项研究，包括作者机构的经验，共纳入 9264 名患者（4671 名 TBI 与 4593 名非 TBI），符合纳入标准；这一总数还包括我们机构系列中的 149 例。分析出版系列结果时，包括和不包括我们的系列，共有 23 项研究报告了总体并发症，40 项报告了感染，10 项报告了新发癫痫，13 项报告了骨瓣吸收（BFR），5 项报告了 CP 后脑积水，10 项报告了颅内出血（ICH），8 项报告了外轴液体积聚（EFC）。TBI 与 BFR（优势比[OR]1.76，p<0.01）和感染（OR 1.38，p=0.02）的几率增加有关。在总体并发症、癫痫、脑积水、ICH 或 EFC 的几率方面没有差异。
在 TBI 患者中，CP 后 BFR 和感染风险增加的意识，促进了预防这些并发症的新策略的实施，特别是在这一类患者中。
