Yamaura A, Sato M, Meguro K, Nakamura T, Uemura K
No Shinkei Geka. 1977 Apr;5(4):345-53.
Three hundred cases of cranioplasty, following large decompressive craniectomy for various diseases, were analyzed. 1. Neurological status was evaluated before and after cranioplasty in 52 patients with remaining neurological deficit. There observed no changes in 13 patients with skin flap of full or bulging type. However, 4 (10%) among 39 patients with skin flap of sinking or flat type showed unquestionable objective improvement within a few days following cranioplasty, after stationary period of more than 2 and half months. In these situation, placement of acrylic plate has presumably corrected deformity of underlying brain tissue secondary to pressure gradient between extra- and intracranial spaces, which might have unidentifiably caused unfavorable eflects on neural function. 2. Seven children underwent procedure within 24 months of age and all of them had troublesome bluging of skin flap. This deformity was extreme in 5, in whom the dura mater was not repaired in the previous surgery. Those children had various intracranial problems as causes of bulging skin flap-hydrocephaly in 2, porencephaly in 1, CSF collection under the skin flap in 4, brain migration in 2, enlarged subarachnoid space over the bulging brain surface in 2, deformity of the skull resembling growing skull fracture in 5; and as complications of cranioplasty in 3 and infection in 2. 3. Fracture of the cranioplasty was seen in 7 (2%) among 300 cases and 6 of them were under the age of 7. In one case, there occurred 3 episodes of fracture. 4. Infected cranioplasty, in all as epidural empyema, was seen in 10 (3%) of 300 cases. One of the most important factors related to infection, was the time interval after the primary surgery; all infected cases were operated on within 3 months.
对300例因各种疾病行大骨瓣减压术后行颅骨修补术的病例进行了分析。1. 对52例仍有神经功能缺损的患者在颅骨修补术前和术后进行了神经功能状态评估。13例皮瓣饱满或膨隆型患者神经功能无变化。然而，39例皮瓣凹陷或扁平型患者中有4例（10%）在颅骨修补术后数天内出现了明确的客观改善，此前有超过两个半月的静止期。在这种情况下，植入丙烯酸板可能纠正了颅内外空间压力梯度导致的潜在脑组织畸形，这种畸形可能在不知不觉中对神经功能产生了不利影响。2. 7名儿童在24个月龄内接受了手术，他们的皮瓣均有明显膨隆。其中5例畸形严重，他们在之前的手术中未修复硬脑膜。这些儿童有各种颅内问题导致皮瓣膨隆——2例为脑积水，1例为脑穿通畸形，4例为皮瓣下脑脊液积聚，2例为脑移位，2例为膨隆脑表面蛛网膜下腔增宽，5例颅骨畸形类似生长性颅骨骨折；3例为颅骨修补术并发症，2例为感染。3. 300例中有7例（2%）出现颅骨修补物骨折，其中6例年龄在7岁以下。有1例发生了3次骨折。4. 300例中有10例（3%）发生了感染性颅骨修补术，均为硬膜外积脓。与感染相关的最重要因素之一是初次手术后的时间间隔；所有感染病例均在3个月内接受手术。
