Hauerberg John, Nielsen Silas Haahr, Mirian Christian, Springborg Jacob Bertram
Department of Neurosurgery, Rigshospitalet , Copenhagen University Hospital, Copenhagen, Denmark.
Acta Neurochir (Wien). 2024 Dec 9;166(1):497. doi: 10.1007/s00701-024-06388-1.
Studies on complications following titanium mesh cranioplasty have predominantly focused on patients with cranial defects after decompressive craniectomy. This study investigates possible risk factors for complications using titanium mesh for smaller cranial defects.
All patients treated with titanium mesh cranioplasty over a 5-year period at Copenhagen University Hospital were identified. Demographics, comorbidities, and active smoking and drinking status were recorded in addition to indication for cranioplasty and operative findings. Severe complications recorded included superficial and deep infection, delayed wound defects, postoperative hematomas, and death within 30 days postoperatively. Minor complications recorded included skin atrophy, cosmetic complaints, pain, and loosening of the mesh. The management of complications was also documented.
A total of 247 patients with primary titanium mesh cranioplasty were included in the study. The overall complication rate was 17.4%. 15.0% suffered from severe complications and 2.4% developed minor complications. Elderly smokers, patients previously treated with radiation, and patients operated via a posterolateral approach to the skull base had the strongest association with complications. The complication rate was not higher in patients with cranioplasty after postoperative infections or in those with a frontobasal approach to the skull base compared with patient operated on for smaller cranial tumors.
The risk of complications following titanium mesh for smaller cranial defects is higher in elderly smokers, patients with a history of radiation, and those undergoing a posterolateral approach to the skull base.
钛网颅骨成形术后并发症的研究主要集中在减压性颅骨切除术后有颅骨缺损的患者。本研究调查了使用钛网修复较小颅骨缺损时可能的并发症危险因素。
确定了哥本哈根大学医院5年内接受钛网颅骨成形术治疗的所有患者。除了颅骨成形术的指征和手术结果外，还记录了人口统计学资料、合并症以及吸烟和饮酒情况。记录的严重并发症包括浅表和深部感染、伤口延迟愈合、术后血肿以及术后30天内死亡。记录的轻微并发症包括皮肤萎缩、美容方面的问题、疼痛和钛网松动。还记录了并发症的处理情况。
本研究共纳入247例行初次钛网颅骨成形术的患者。总体并发症发生率为17.4%。15.0%的患者发生严重并发症，2.4%的患者出现轻微并发症。老年吸烟者、既往接受过放疗的患者以及经后外侧入路至颅底手术的患者与并发症的关联最为密切。与因较小颅骨肿瘤接受手术的患者相比，术后感染后行颅骨成形术的患者或经额底入路至颅底手术的患者并发症发生率并未更高。
老年吸烟者、有放疗史的患者以及经后外侧入路至颅底手术的患者使用钛网修复较小颅骨缺损后发生并发症的风险更高。
