Bschorer Maximilian, Giese Henrik, Höhne Julius, Schebesch Karl Michael, Henker Christian, Strauss Andreas, Wolfert Christina, Gaber Khaled, Krigers Aleksandrs, Petr Ondra, Butenschoen Vicki M, Krieg Sandro M, Mende Klaus Christian, Lindner Dirk, Regelsberger Jan, Mielke Dorothee, Sauvigny Thomas
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neurosurgery, Hospital Center Braunschweig, Braunschweig, Germany.
Brain Spine. 2025 Jul 2;5:104308. doi: 10.1016/j.bas.2025.104308. eCollection 2025.
This international prospective multicenter cohort study investigates the long-term surgical complication rate and neurological outcomes in patients who underwent autologous or allogeneic cranioplasty (CP) after decompressive craniectomy (DC) for traumatic brain injury, stroke, aneurysmatic subarachnoid hemorrhage, and intracranial hemorrhage.
This study investigated the predictors of long-term outcomes and surgical revision after cranioplasty.
Patients who underwent CP with a minimum follow-up of at least 12 months were included. Favorable long-term outcome (FLTO) was defined as a Glasgow Outcome Score (GOS) of 4 or 5 and a modified Rankin scale (mRS) score of <4. Univariate and multivariate analyses were performed.
A total of 200 patients with a median follow-up of 883.1 520.5 days were included. Ninety-nine patients (50.0 %) had a FLTO, and the surgical revision rate was 25.0 % (n = 50). Thirty-eight percent (37.7 %) and 27.5 % of patients showed improvement in the mRS and GOS scores, respectively. Simultaneous implantation of a ventriculoperitoneal shunt (OR 6.114) and a time interval of <90 days between DC and CP (OR 2.189) predicted an increase in reoperation rates. The use of subcutaneous drains with suction predicted a lower rate of reoperation (OR .410). Diabetes mellitus (OR .221) and reoperations during the initial stay (OR .347) were negative predictors of FLTO. Implants imbued with antibiotics predicted a positive FLTO (OR 2.973).
Suction drains were predicted to reduce reoperation rates. Simultaneous implantation of VPS and CP within 3 months of DC predicted an increased likelihood of surgical revision.
这项国际前瞻性多中心队列研究调查了因创伤性脑损伤、中风、动脉瘤性蛛网膜下腔出血和颅内出血行减压性颅骨切除术后接受自体或异体颅骨成形术（CP）患者的长期手术并发症发生率和神经学预后。
本研究调查了颅骨成形术后长期预后和手术翻修的预测因素。
纳入接受CP且至少随访12个月的患者。良好的长期预后（FLTO）定义为格拉斯哥预后评分（GOS）为4或5且改良Rankin量表（mRS）评分<4。进行单因素和多因素分析。
共纳入200例患者，中位随访时间为883.1±520.5天。99例患者（50.0%）有良好的长期预后，手术翻修率为25.0%（n = 50）。分别有37.7%和27.5%的患者mRS和GOS评分有所改善。同时植入脑室腹腔分流管（OR 6.114）以及减压性颅骨切除术和颅骨成形术之间的时间间隔<90天（OR 2.189）预示再次手术率增加。使用带吸引装置的皮下引流管预示再次手术率较低（OR 0.410）。糖尿病（OR 0.221）和初次住院期间再次手术（OR 0.347）是良好长期预后的负性预测因素。含抗生素的植入物预示有良好的长期预后（OR 2.973）。
预计吸引引流管可降低再次手术率。在减压性颅骨切除术后3个月内同时植入脑室腹腔分流管和颅骨成形术预示手术翻修的可能性增加。
