Guo P, Li T, Peng Y T, Wu W Q, Zhang H Y, Yang Z W, Song Y L, Li J P
Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Wai Ke Za Zhi. 2024 Dec 1;62(12):1120-1127. doi: 10.3760/cma.j.cn112139-20240330-00154.
To explore the clinical effects of a 3D-printed intracranial pressure balancing device in preventing complications after suboccipital craniectomy (DC). This study is a retrospective cohort analysis. The clinical data of 35 patients who underwent DC at Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, from September 2020 to September 2023 were reviewed. The cohort included 24 males and 11 females, with an age of (48.7±14.9) years (range:17 to 74 years). Nineteen patients (experimental group) received the intracranial pressure balancing device fixed to the bone defect site post-DC. This device was made using medical-grade dicyanamide resin and was three dimensional printed based on postoperative CT scans of the patients. The remaining 16 patients (control group) did not receive the intracranial pressure balancing device, while other treatments and procedures were consistent with the experimental group. Data were compared using the test or Fisher's exact probability method. Out of the 35 patients, 30 cases (85.7%) experienced complications following DC. Specific complications included cerebral infarction in 3 cases (8.6%), intracerebral hemorrhage in 1 case (2.9%), subdural effusion in 27 cases (77.1%) with a median onset of (8.8±6.5) days (range: 1 to 23 days), brain tissue protrusion in 15 cases (42.9%) with a median onset of ((IQR)) 7.0 (21.0) days (range:2 to 106 days), and hydrocephalus in 6 cases (17.14%) with a median onset of 34.5 (111.0) days (range: 22 to 136 days). There were no significant differences in the occurrence of complications(all >0.05). However, there was a significant reduction in the incidence of subdural effusion in the experimental group prior to cranioplasty (=0.013). No significant differences were noted in mRS scores between the two groups after cranioplasty (>0.05). The intracranial pressure balancing device has the effect of prevention and treatment of subdural effusion. However, it did not significantly improve patient prognosis post-DC, warranting further investigation.
探讨3D打印颅内压平衡装置在枕下开颅术后预防并发症的临床效果。本研究为回顾性队列分析。回顾了2020年9月至2023年9月在首都医科大学附属北京朝阳医院神经外科接受枕下开颅术的35例患者的临床资料。该队列包括24例男性和11例女性，年龄为（48.7±14.9）岁（范围：17至74岁）。19例患者（实验组）在枕下开颅术后接受了固定于骨缺损部位的颅内压平衡装置。该装置采用医用级双氰胺树脂制成，并根据患者术后CT扫描进行三维打印。其余16例患者（对照组）未接受颅内压平衡装置，其他治疗和操作与实验组一致。数据采用检验或Fisher精确概率法进行比较。35例患者中，30例（85.7%）在枕下开颅术后出现并发症。具体并发症包括脑梗死3例（8.6%）、脑出血1例（2.9%）、硬膜下积液27例（77.1%），中位发病时间为（8.8±6.5）天（范围：1至23天）、脑组织膨出15例（42.9%），中位发病时间为（四分位间距）7.0（21.0）天（范围：2至106天）、脑积水6例（17.14%），中位发病时间为34.5（111.0）天（范围：22至136天）。并发症的发生率无显著差异（均>0.05）。然而，实验组在颅骨成形术前硬膜下积液的发生率显著降低（=0.013）。颅骨成形术后两组之间的改良Rankin量表评分无显著差异（>0.05）。颅内压平衡装置具有防治硬膜下积液的作用。然而，它并未显著改善枕下开颅术后患者的预后，有待进一步研究。
