医学
颅骨成形术
外科
回顾性队列研究
去骨瓣减压术
单变量分析
创伤性脑损伤
格拉斯哥昏迷指数
逻辑回归
蛛网膜下腔出血
麻醉
开颅术
脑积水
并发症
多元分析
内科学
精神科
颅骨
作者
Michael Veldeman,Lorina Daleiden,Hussam Aldin Hamou,Anke Höllig,Hans Clusmann
出处
期刊:Journal of Neurosurgery
[Journal of Neurosurgery Publishing Group]
日期:2021-04-01
卷期号:134 (4): 1262-1270
被引量:14
标识
DOI:10.3171/2020.2.jns193335
摘要
Performing a cranioplasty (CP) after decompressive craniotomy is a straightforward neurosurgical procedure, but it remains associated with a high complication rate. Surgical site infection (SSI), aseptic bone resorption (aBR), and need for a secondary CP are the most common complications. This observational study aimed to identify modifiable risk factors to prevent CP failure.A retrospective analysis was performed of all patients who underwent CP following decompressive hemicraniectomy (DHC) between 2010 and 2018 at a single institution. Predictors of SSI, aBR, and need for allograft CP were evaluated in a univariate analysis and multivariate logistic regression model.One hundred eighty-six patients treated with CP after DHC were included. The diagnoses leading to a DHC were as follows: stroke (83 patients, 44.6%), traumatic brain injury (55 patients, 29.6%), subarachnoid hemorrhage (33 patients, 17.7%), and intracerebral hemorrhage (15 patients, 8.1%). Post-CP SSI occurred in 25 patients (13.4%), whereas aBR occurred in 32 cases (17.2%). An altered posterior question-mark incision, ending behind the ear, was associated with a significantly lower infection rate and CP failure, compared to the classic question-mark incision (6.3% vs 18.4%; p = 0.021). The only significant predictor of aBR was patient age, in which those developing resorption were on average 16 years younger than those without aBR (p < 0.001).The primary goal of this retrospective cohort analysis was to identify adjustable risk factors to prevent post-CP complications. In this analysis, a posterior question-mark incision proved beneficial regarding infection and CP failure. The authors believe that these findings are caused by the better vascularized skin flap due to preservation of the superficial temporal artery and partial preservation of the occipital artery. In this trial, the posterior question-mark incision was identified as an easily and costless adaptable technique to reduce CP failure rates.
科研通智能强力驱动
Strongly Powered by AbleSci AI