1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands.
2Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom.
J Neurosurg. 2024 Apr 26;141(4):895-907. doi: 10.3171/2024.1.JNS232172. Print 2024 Oct 1.
The aim of this study was to compare the outcomes of early (≤ 90 days) and delayed (> 90 days) cranioplasty following decompressive craniectomy (DC) in patients with traumatic brain injury (TBI).
The authors analyzed participants enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) and the Neurotraumatology Quality Registry (Net-QuRe) studies who were diagnosed with TBI and underwent DC and subsequent cranioplasty. These prospective, multicenter, observational cohort studies included 5091 patients enrolled from 2014 to 2020. The effect of cranioplasty timing on functional outcome was evaluated with multivariable ordinal regression and with propensity score matching (PSM) in a sensitivity analysis of functional outcome (Glasgow Outcome Scale-Extended [GOSE] score) and quality of life (Quality of Life After Brain Injury [QOLIBRI] instrument) at 12 months following DC.
Among 173 eligible patients, 73 (42%) underwent early cranioplasty and 100 (58%) underwent delayed cranioplasty. In the ordinal logistic regression and PSM, similar 12-month GOSE scores were found between the two groups (adjusted odds ratio [aOR] 0.87, 95% CI 0.61-1.21 and 0.88, 95% CI 0.48-1.65, respectively). In the ordinal logistic regression, early cranioplasty was associated with a higher risk for hydrocephalus than that with delayed cranioplasty (aOR 4.0, 95% CI 1.2-16). Postdischarge seizure rates (early cranioplasty: aOR 1.73, 95% CI 0.7-4.7) and QOLIBRI scores (β -1.9, 95% CI -9.1 to 9.6) were similar between the two groups.
Functional outcome and quality of life were similar between early and delayed cranioplasty in patients who had undergone DC for TBI. Neurosurgeons may consider performing cranioplasty during the index admission (early) to simplify the patient's chain of care and prevent readmission for cranioplasty but should be vigilant for an increased possibility of hydrocephalus. Clinical trial registration nos.: CENTER-TBI, NCT02210221 (clinicaltrials.gov); Net-QuRe, NTR6003 (trialsearch.who.int) and NL5761 (onderzoekmetmensen.nl).
本研究旨在比较创伤性脑损伤（TBI）患者行去骨瓣减压术后早期（≤90 天）和晚期（＞90 天）颅骨修补术的结局。
作者分析了 2014 年至 2020 年期间参加协作性欧洲神经创伤效力研究在创伤性脑损伤（CENTER-TBI）和神经创伤学质量登记处（Net-QuRe）研究的参与者，这些参与者被诊断为 TBI 并接受了去骨瓣减压术和随后的颅骨修补术。这些前瞻性、多中心、观察性队列研究纳入了 5091 名患者。使用多变量有序回归和倾向评分匹配（PSM）对颅骨修补时机对功能结局的影响进行评估，在敏感性分析中评估了功能结局（格拉斯哥结局量表扩展版[GOSE]评分）和生活质量（脑损伤后生活质量[QOLIBRI]量表）在去骨瓣减压术后 12 个月的情况。
在 173 名符合条件的患者中，73 名（42%）患者行早期颅骨修补术，100 名（58%）患者行晚期颅骨修补术。在有序逻辑回归和 PSM 中，两组 12 个月时的 GOSE 评分相似（调整后的优势比[aOR]0.87，95%CI0.61-1.21 和 0.88，95%CI0.48-1.65）。在有序逻辑回归中，早期颅骨修补术与脑积水的风险高于晚期颅骨修补术（aOR4.0，95%CI1.2-16）相关。出院后癫痫发作率（早期颅骨修补术：aOR1.73，95%CI0.7-4.7）和 QOLIBRI 评分（β-1.9，95%CI-9.1 至 9.6）在两组之间相似。
在 TBI 患者中，去骨瓣减压术后早期和晚期颅骨修补术的功能结局和生活质量相似。神经外科医生可能会考虑在指数入院期间（早期）进行颅骨修补术，以简化患者的治疗链并预防因颅骨修补术而再次入院，但应警惕脑积水的可能性增加。临床试验注册号：CENTER-TBI，NCT02210221（clinicaltrials.gov）；Net-QuRe，NTR6003（trialsearch.who.int）和 NL5761（onderzoekmetmensen.nl）。
