From the Department of Plastic Surgery.
Department of Neurological Surgery, Cleveland Clinic; Cleveland, OH.
Ann Plast Surg. 2023 Aug 1;91(2):225-231. doi: 10.1097/SAP.0000000000003564. Epub 2023 Jun 1.
This study aimed to formulate reconstructive recommendations for neurosurgical patients presenting with scalp and/or skull defects based on outcomes in a large series of patients.
An institutional review board-approved retrospective review of patients who underwent scalp and/or calvarial reconstruction was conducted. Complications were divided into minor and major; early, intermediate, and late. Univariate logistic regression models were conducted to identify independent predictors of complications. Mann-Whitney U tests were used to compare survival time. Kaplan-Meier curves were developed to compare exposure of titanium and bone cranioplasties.
One hundred seventy-one patients who underwent 418 procedures were included (median 1 [1-3] surgeries per patient). Average age was 55 ± 15 years; 53% of patients were male. Median follow-up was 25.5 months [13.9-55.6 months], and 57 patients (33%) were deceased. Complications occurred following 48% of procedures; most common were titanium hardware exposure (36%), nonhealing wounds (23%), and infection (9%). Titanium cranioplasties became exposed 0.47 months [0.3-4.0 months] postoperatively. Frontal defect location was an independent predictor of major complications (odds ratio, 1.59; 95% confidence interval, 1.06-2.39; P = 0.026). Mortality rate for malignant intracranial neoplasms was 68.4% (median survival, 4.3 months), 39.1% for malignancies of both scalp and skull (7.0 months), 37.5% for scalp cancers (16.0 months), and 16.7% for meningiomas (28.2 months).
Neurosurgical patients requiring scalp and/or skull reconstruction are a complex population undergoing multiple procedures with high complication rates. Given high exposure rate of titanium hardware shortly after reconstruction, titanium cranioplasty is recommended for patients with a prognosis less than 2 to 8 months.
本研究旨在根据大量患者的结果，为存在头皮和/或颅骨缺损的神经外科患者制定重建建议。
对接受头皮和/或颅骨重建的患者进行了机构审查委员会批准的回顾性研究。将并发症分为轻微和严重；早期、中期和晚期。采用单变量逻辑回归模型确定并发症的独立预测因素。采用 Mann-Whitney U 检验比较生存时间。绘制 Kaplan-Meier 曲线比较钛和骨颅骨修复体的暴露情况。
共纳入 171 例患者（n=418 例），平均年龄为 55±15 岁，53%为男性。中位随访时间为 25.5 个月（13.9-55.6 个月），57 例（33%）患者死亡。48%的手术出现并发症；最常见的是钛金属硬件暴露（36%）、伤口不愈合（23%）和感染（9%）。钛颅骨修复术后 0.47 个月（0.3-4.0 个月）出现暴露。额部缺损位置是严重并发症的独立预测因素（优势比，1.59；95%置信区间，1.06-2.39；P=0.026）。颅内恶性肿瘤的死亡率为 68.4%（中位生存时间为 4.3 个月），头皮和颅骨恶性肿瘤的死亡率为 39.1%（7.0 个月），头皮癌的死亡率为 37.5%（16.0 个月），脑膜瘤的死亡率为 16.7%（28.2 个月）。
需要头皮和/或颅骨重建的神经外科患者是一个复杂的人群，他们需要接受多次手术，并发症发生率高。鉴于重建后钛金属硬件的高暴露率，建议预后少于 2 至 8 个月的患者使用钛颅骨修复体。
