Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom.
Br J Neurosurg. 2022 Jun;36(3):385-393. doi: 10.1080/02688697.2022.2077311. Epub 2022 May 24.
Cranioplasty remains an essential procedure following craniectomy but is associated with high morbidity. We investigated factors associated with outcomes following first alloplastic cranioplasty.
A single-centre, retrospective cohort study of patients undergoing first alloplastic cranioplasty at a tertiary neuroscience centre (01 March 2010-01 September 2021). Patient demographics and craniectomy/cranioplasty details were extracted. Primary outcome was all-cause explantation. Secondary outcomes were explantation secondary to infection, surgical morbidity and mortality. Multivariable analysis was performed using Cox proportional hazards regression or binary logistic regression.
Included were 287 patients with a mean age of 42.9 years [SD = 15.4] at time of cranioplasty. The most common indication for craniectomy was traumatic brain injury (32.1%, n = 92). Cranioplasty materials included titanium plate (23.3%, n = 67), hydroxyapatite (22.3%, n = 64), acrylic (20.6%, n = 59), titanium mesh (19.2%, n = 55), hand-moulded PMMA cement (9.1%, n = 26) and PEEK (5.6%, n = 16). Median follow-up time after cranioplasty was 86.5 months (IQR 44.6-111.3). All-cause explantation was 12.2% (n = 35). Eighty-three patients (28.9%) had surgical morbidity. In multivariable analysis, the risk of all-cause explantation and explantation due to infection was reduced with the use of both hydroxyapatite (HR 0.22 [95% CI 0.07-0.71], = .011, HR 0.22 [95% CI 0.05-0.93], = .040) and acrylic (HR 0.20 [95% CI 0.06-0.73], = .015, HR 0.24 [95% CI 0.06-0.97], = .045), respectively. In addition, risk of explantation due to infection was increased when time to cranioplasty was between three and six months (HR 6.38 [95% CI 1.35-30.19], = .020). Mean age at cranioplasty (HR 1.47 [95% CI 1.03-2.11], = .034), titanium mesh (HR 5.36 [95% CI 1.88-15.24], = .002), and use of a drain (HR 3.37 [95% CI 1.51-7.51], = .003) increased risk of mortality.
Morbidity is high following cranioplasty, with over a tenth requiring explantation. Hydroxyapatite and acrylic were associated with reduced risk of all-cause explantation and explantation due to infection. Cranioplasty insertion at three to six months was associated with increased risk of explantation due to infection.
颅骨成形术仍是颅骨切除术的重要后续治疗手段，但与之相关的发病率较高。本研究旨在调查首例异体颅骨成形术后结局的相关影响因素。
对在三级神经科学中心（2010 年 3 月 1 日至 2021 年 9 月 1 日）接受首例异体颅骨成形术的患者进行单中心回顾性队列研究。患者的人口统计学和颅骨切除术/颅骨成形术的详细信息被提取出来。主要结局是所有原因的假体取出。次要结局为感染、手术发病率和死亡率导致的假体取出。使用 Cox 比例风险回归或二项逻辑回归进行多变量分析。
共纳入 287 例患者，颅骨成形术时的平均年龄为 42.9 岁[标准差（SD）=15.4]。颅骨切除术最常见的指征是创伤性脑损伤（32.1%，n=92）。颅骨成形术材料包括钛板（23.3%，n=67）、羟基磷灰石（22.3%，n=64）、丙烯酸（20.6%，n=59）、钛网（19.2%，n=55）、手工成型 PMMA 水泥（9.1%，n=26）和聚醚醚酮（5.6%，n=16）。颅骨成形术后的中位随访时间为 86.5 个月（IQR 44.6-111.3）。所有原因的假体取出率为 12.2%（n=35）。83 例患者（28.9%）发生手术并发症。多变量分析显示，使用羟基磷灰石（HR 0.22[95%CI 0.07-0.71]，=0.011，HR 0.22[95%CI 0.05-0.93]，=0.040）和丙烯酸（HR 0.20[95%CI 0.06-0.73]，=0.015，HR 0.24[95%CI 0.06-0.97]，=0.045）可降低所有原因假体取出和感染导致假体取出的风险。此外，颅骨成形术至感染的时间在 3 至 6 个月之间时，感染导致假体取出的风险增加（HR 6.38[95%CI 1.35-30.19]，=0.020）。颅骨成形术时的平均年龄（HR 1.47[95%CI 1.03-2.11]，=0.034）、钛网（HR 5.36[95%CI 1.88-15.24]，=0.002）和引流管的使用（HR 3.37[95%CI 1.51-7.51]，=0.003）增加了死亡率的风险。
颅骨成形术后发病率较高，超过十分之一的患者需要取出假体。羟基磷灰石和丙烯酸与降低所有原因假体取出和感染导致假体取出的风险相关。颅骨成形术在 3 至 6 个月之间进行与感染导致假体取出的风险增加有关。
