Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Oper Neurosurg (Hagerstown). 2023 Jul 1;25(1):72-80. doi: 10.1227/ons.0000000000000689. Epub 2023 May 5.
Although not a technically difficult operation, cranioplasty is associated with high rates of complications. The optimal timing of cranioplasty to mitigate complications remains the subject of debate.
To report outcomes between patients undergoing cranioplasty at ultra-early (0-6 weeks), intermediate (6 weeks to 6 months), and late (>6 months) time frames. We report a novel craniectomy contour classification (CCC) as a radiographic parameter to assess readiness for cranioplasty.
A single-institution retrospective analysis of patients undergoing cranioplasty was performed. Patients were stratified into ultra-early (within 6 weeks of index craniectomy), intermediate (6 weeks to 6 months), and late (>6 months) cranioplasty cohorts. We have devised CCC scores, A, B, and C, based on radiographic criteria, where A represents those with a sunken brain/flap, B with a normal parenchymal contour, and C with "full" parenchyma.
A total of 119 patients were included. There was no significant difference in postcranioplasty complications, including return to operating room ( P = .212), seizures ( P = .556), infection ( P = .140), need for shunting ( P = .204), and deep venous thrombosis ( P = .066), between the cohorts. Univariate logistic regression revealed that ultra-early cranioplasty was significantly associated with higher rate of functional independence at >6 months (odds ratio 4.32, 95% CI 1.39-15.13, P = .015) although this did not persist when adjusting for patient selection features (odds ratio 2.90, 95% CI 0.53-19.03, P = .234).
In appropriately selected patients, ultra-early cranioplasty is not associated with increased rate of postoperative complications and is a viable option. The CCC may help guide decision-making on timing of cranioplasty.
虽然颅骨成形术不是一项技术上困难的手术，但它与高并发症发生率相关。减轻并发症的最佳颅骨成形术时机仍然存在争议。
报告在超早期（0-6 周）、中期（6 周到 6 个月）和晚期（>6 个月）时间框架内接受颅骨成形术的患者的结局。我们报告了一种新的颅骨切除术轮廓分类（CCC），作为评估颅骨成形术准备情况的影像学参数。
对一家机构进行回顾性分析，对接受颅骨成形术的患者进行分析。患者被分为超早期（颅骨切除术6 周内）、中期（6 周到 6 个月）和晚期（>6 个月）颅骨成形术队列。我们根据影像学标准设计了 CCC 评分 A、B 和 C，其中 A 代表脑陷或皮瓣，B 代表正常脑实质轮廓，C 代表“完全”脑实质。
共纳入 119 例患者。在颅骨成形术后并发症方面，各组之间没有显著差异，包括重返手术室（P=0.212）、癫痫发作（P=0.556）、感染（P=0.140）、需要分流（P=0.204）和深静脉血栓形成（P=0.066）。单变量逻辑回归显示，超早期颅骨成形术与>6 个月时更高的功能独立性率显著相关（优势比 4.32，95%置信区间 1.39-15.13，P=0.015），但在调整患者选择特征后，这种相关性并不存在（优势比 2.90，95%置信区间 0.53-19.03，P=0.234）。
在适当选择的患者中，超早期颅骨成形术不会增加术后并发症的发生率，是一种可行的选择。CCC 可能有助于指导颅骨成形术时机的决策。
