Johnson W Chase, Ravindra Vijay M, Fielder Tristan, Ishaque Mariam, Patterson T Tyler, McGinity Michael J, Lacci John V, Grandhi Ramesh
Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA.
Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California, USA.
Neurotrauma Rep. 2021 Aug 27;2(1):391-398. doi: 10.1089/neur.2021.0015. eCollection 2021.
Skull bone graft failure is a potential complication of autologous cranioplasty after decompressive craniectomy (DC). Our objective was to investigate the association of graft size with subsequent bone graft failure after autologous cranioplasty. This single-center retrospective cohort study included patients age ≥18 years who underwent primary autologous cranioplasty between 2010 and 2017. The primary outcome was bone flap failure requiring graft removal. Demographic, clinical, and radiographic factors were recorded; three-dimensional (3D) reconstructive imaging was used to perform accurate measurements. Univariate and multi-variate regression analysis were performed to identify risk factors for the primary outcome. Of the 131 patients who underwent primary autologous cranioplasty, 25 (19.0%) underwent removal of the graft after identification of bone flap necrosis on computed tomography (CT); 16 (64%) of these were culture positive. The mean surface area of craniectomy defect was 128.5 cm for patients with bone necrosis and 114.9 cm for those without bone necrosis. Linear regression analysis demonstrated that size of craniectomy defect was independently associated with subsequent bone flap failure; logistic regression analysis demonstrated a defect area >125 cm was independently associated with failure (odds ratio [OR] 3.29; confidence interval [CI]: 0.249-2.135). Patient- and operation-specific variables were not significant predictors of bone necrosis. Our results showed that increased size of antecedent DC is an independent risk factor for bone flap failure after autologous cranioplasty. Given these findings, clinicians should consider the increased potential of bone flap failure after autologous cranioplasty among patients whose initial DC was >125 cm.
颅骨瓣移植失败是减压性颅骨切除术后自体颅骨成形术的一种潜在并发症。我们的目的是研究自体颅骨成形术后移植骨大小与随后的骨移植失败之间的关联。这项单中心回顾性队列研究纳入了2010年至2017年间接受初次自体颅骨成形术、年龄≥18岁的患者。主要结局是需要移除移植骨的骨瓣失败。记录了人口统计学、临床和影像学因素；使用三维（3D）重建成像进行精确测量。进行单变量和多变量回归分析以确定主要结局的危险因素。在131例接受初次自体颅骨成形术的患者中，25例（19.0%）在计算机断层扫描（CT）上发现骨瓣坏死后接受了移植骨移除；其中16例（64%）培养结果呈阳性。骨坏死患者颅骨切除缺损的平均表面积为128.5平方厘米，无骨坏死患者为114.9平方厘米。线性回归分析表明，颅骨切除缺损的大小与随后的骨瓣失败独立相关；逻辑回归分析表明，缺损面积>125平方厘米与失败独立相关（比值比[OR]3.29；置信区间[CI]：0.249 - 2.135）。患者和手术相关变量不是骨坏死的显著预测因素。我们的结果表明，先前减压性颅骨切除术缺损大小增加是自体颅骨成形术后骨瓣失败的独立危险因素。鉴于这些发现，临床医生应考虑初始减压性颅骨切除术缺损>125平方厘米的患者自体颅骨成形术后骨瓣失败的可能性增加。
