Department of Neurosurgery, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Germany.
Acta Neurochir (Wien). 2024 Sep 25;166(1):380. doi: 10.1007/s00701-024-06282-w.
The reimplantation of autologous bone grafts after decompressive craniectomy (DC) is still up for debate. The objective of this study was to analyze the surgical revision rate for autologous cranioplasties in our center, aiming to identify predictors for procedure-related-complications.
A retrospective single-center study was conducted for adult patients who underwent autologous cranioplasty after DC. The primary endpoint was the complication rate in terms of surgical revision and removal of the bone graft: infection, new onset seizures, dislocation, haemorrhage, osteolysis, wound dehiscence and cerebrospinal fluid (CSF) fistula. Demographic data, medical records, surgical reports and imaging studies were analysed and risk factors for complications were evaluated.
169 consecutive patients were included. The median interval between DC and cranioplasty was 84 days. Mean age was 51 ± 12.4 years. 26 patients (15.3%) had revision surgery for following reasons. n = 9 implant dislocations (5.3%), n = 7 osteolysis (3.6%), n = 6 infections (3.6%), n = 5 had re-bleedings (3%), n = 5 wound dehiscences (3%), and n = 2 CSF fistulas (1.2%). 18 patients developed new seizures (10.7%). Bi- and multivariate analysis revealed three independent risk factors, simultaneous ventriculo-peritoneal (VP) shunting increased the risk for material dislocation (p < 0.001); large bone grafts (> 193.5 cm) increased the risk for osteolysis (p = 0.001) and bifrontal cranioplasties were associated with higher risk for infections (p = 0.04).
The complication rates in our study were comparable to previously reported data for autologous or artificial cranioplasties. As osteolysis was correlated to larger bone grafts, a synthetic alternative should be considered in selected cases.
去骨瓣减压术后（DC）自体骨移植物的再植入仍然存在争议。本研究的目的是分析我们中心自体颅骨修补术的手术修正率，旨在确定与手术相关并发症的预测因素。
对在 DC 后接受自体颅骨修补术的成年患者进行回顾性单中心研究。主要终点是手术修正和移植物去除的并发症发生率：感染、新发癫痫发作、脱位、出血、骨溶解、伤口裂开和脑脊液（CSF）瘘。分析人口统计学数据、病历、手术报告和影像学研究，并评估并发症的危险因素。
共纳入 169 例连续患者。DC 与颅骨修补术之间的中位间隔时间为 84 天。平均年龄为 51±12.4 岁。26 例（15.3%）因以下原因行修正手术。n=9 例植入物脱位（5.3%），n=7 例骨溶解（3.6%），n=6 例感染（3.6%），n=5 例再出血（3%），n=5 例伤口裂开（3%），n=2 例 CSF 瘘（1.2%）。18 例患者出现新的癫痫发作（10.7%）。双变量和多变量分析显示有三个独立的危险因素，同时行脑室-腹腔（VP）分流术会增加材料脱位的风险（p<0.001）；较大的骨移植物（>193.5cm）会增加骨溶解的风险（p=0.001），双侧额颅骨修补术与感染风险增加相关（p=0.04）。
我们的研究中并发症发生率与以前报道的自体或人工颅骨修补术的数据相当。由于骨溶解与较大的骨移植物相关，在某些情况下应考虑使用合成替代品。
