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Exploring complications following cranioplasty after decompressive hemicraniectomy: A retrospective bicenter assessment of autologous, PMMA and CAD implants
Neurosurgical Review ( IF 2.5 ) Pub Date : 2024-01-29 , DOI: 10.1007/s10143-024-02309-z
A Pfnür 1 , D Tosin 2 , M Petkov 2 , O Sharon 1 , B Mayer 3 , C R Wirtz 1, 2 , A Knoll 1 , A Pala 2
Affiliation  

Cranioplasty (CP) after decompressive hemicraniectomy (DHC) is a common neurosurgical procedure with a high complication rate. The best material for the repair of large cranial defects is unclear. The aim of this study was to evaluate different implant materials regarding surgery related complications after CP. Type of materials include the autologous bone flap (ABF), polymethylmethacrylate (PMMA), calcium phosphate reinforced with titanium mesh (CaP-Ti), polyetheretherketone (PEEK) and hydroxyapatite (HA). A retrospective, descriptive, observational bicenter study was performed, medical data of all patients who underwent CP after DHC between January 1st, 2016 and December 31st, 2022 were analyzed. Follow-up was until December 31st, 2023. 139 consecutive patients with a median age of 54 years who received either PMMA (56/139; 40.3%), PEEK (35/139; 25.2%), CaP-Ti (21/139; 15.1%), ABF (25/139; 18.0%) or HA (2/139; 1.4%) cranial implant after DHC were included in the study. Median time from DHC to CP was 117 days and median follow-up period was 43 months. Surgical site infection was the most frequent surgery-related complication (13.7%; 19/139). PEEK implants were mostly affected (28.6%; 10/35), followed by ABF (20%; 5/25), CaP-Ti implants (9.5%; 2/21) and PMMA implants (1.7%, 1/56). Explantation was necessary for 9 PEEK implants (25.7%; 9/35), 6 ABFs (24.0%; 6/25), 3 CaP-Ti implants (14.3%; 3/21) and 4 PMMA implants (7.1%; 4/56). Besides infection, a postoperative hematoma was the most common cause. Median surgical time was 106 min, neither longer surgical time nor use of anticoagulation were significantly related to higher infection rates (p = 0.547; p = 0.152 respectively). Ventriculoperitoneal shunt implantation prior to CP was noted in 33.8% (47/139) and not significantly associated with surgical related complications. Perioperative lumbar drainage, due to bulging brain, inserted in 38 patients (27.3%; 38/139) before surgery was protective when it comes to explantation of the implant (p = 0.035). Based on our results, CP is still related to a relatively high number of infections and further complications. Implant material seems to have a high effect on postoperative infections, since surgical time, anticoagulation therapy and hydrocephalus did not show a statistically significant effect on postoperative complications in this study. PEEK implants and ABFs seem to possess higher risk of postoperative infection. More biocompatible implants such as CaP-Ti might be beneficial. Further, prospective studies are necessary to answer this question.



中文翻译:


探索减压偏侧切除术后颅骨成形术后并发症:自体、PMMA 和 CAD 植入物的回顾性双中心评估



减压半颅切除术 (DHC) 后的颅骨成形术 (CP) 是一种常见的神经外科手术,并发症发生率很高。修复大颅缺损的最佳材料尚不清楚。本研究的目的是评估不同植入物材料对 CP 后手术相关并发症的影响。材料类型包括自体骨瓣 (ABF)、聚甲基丙烯酸甲酯 (PMMA)、钛网增强磷酸钙 (CaP-Ti)、聚醚醚酮 (PEEK) 和羟基磷灰石 (HA)。进行了一项回顾性、描述性、观察性双中心研究,分析了 2016 年 1 月 1 日至 2022 年 12 月 31 日期间 DHC 后接受 CP 的所有患者的医疗数据。随访至 2023 年 12 月 31 日。连续 139 例中位年龄为 54 岁的患者在 DHC 后接受了 PMMA (56/139; 40.3%)、PEEK (35/139; 25.2%)、CaP-Ti (21/139; 15.1%)、ABF (25/139; 18.0%) 或 HA (2/139; 1.4%) 颅骨植入。从 DHC 到 CP 的中位时间为 117 天,中位随访时间为 43 个月。手术部位感染是最常见的手术相关并发症 (13.7%;19/139)。PEEK 植入物受影响最大 (28.6%;10/35),其次是 ABF (20%;5/25)、CaP-Ti 植入物 (9.5%;2/21) 和 PMMA 植入物 (1.7%,1/56)。9 个 PEEK 植入物 (25.7%;9/35)、6 个 ABF (24.0%;6/25)、3 个 CaP-Ti 植入物 (14.3%;3/21) 和 4 个 PMMA 植入物 (7.1%;4/56) 需要移植。除感染外,术后血肿是最常见的原因。中位手术时间为 106 分钟,较长的手术时间和抗凝治疗的使用均与较高的感染率不显著相关 (p = 0.547;p = 0.152)。在 CP 之前观察到 33 例脑室腹腔分流植入。8% (47/139) 且与手术相关并发症无显著相关性。38 例患者 (27.3%;38/139) 在手术前因脑膨出而植入围手术期腰椎引流,对植入物的移植具有保护作用 (p = 0.035)。根据我们的结果,CP 仍然与相对较高的感染数量和进一步的并发症有关。植入物材料似乎对术后感染有很高的影响,因为在这项研究中,手术时间、抗凝治疗和脑积水对术后并发症没有显示出统计学意义的影响。PEEK 植入物和 ABF 似乎具有更高的术后感染风险。更具生物相容性的植入物,例如 CaP-Ti 可能是有益的。此外,需要前瞻性研究来回答这个问题。

更新日期:2024-01-29
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