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60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Decompressive craniectomy without watertight duroplasty

Meeting Abstract

  • E. Güresir - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • H. Vatter - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • P. Schuss - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • Á. Oszvald - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • J. Beck - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.03-03

DOI: 10.3205/09dgnc012, URN: urn:nbn:de:0183-09dgnc0124

Veröffentlicht: 20. Mai 2009

© 2009 Güresir et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Decompressive craniectomy (DC) is effective in the treatment of elevated intracranial pressure (ICP) and usually performed as an emergency procedure following trauma or brain swelling of other aetiology. However, controversy still exists concerning the necessity for duroplasty after DC, which prolongs operative time in a subset of severely ill patients that quite frequently also need further therapy of other operative departments. Therefore, we analyzed the necessity of duroplasty after DC.

Methods: Between March 2002 and August 2008, DC was performed 336 times in 321 patients. During the procedure a large bone flap was removed and the dura opened in a stellate fashion. Exposed brain tissue was covered by surgicel. Patients were stratified according to the indication for DC: (1) traumatic brain injury (TBI), (2) subarachnoid haemorrhage (SAH), (3) intracerebral haemorrhage (ICH), (4) cerebral infarction and (5) other reasons. Complications of DC and of cranioplasty were entered into a database and analysed retrospectively.

Results: Classified according to the underlying pathology, 136 procedures (40.5%) were performed due to TBI, 52 (15.5%) due to SAH, 30 (8.9%) due to ICH, 88 (26.2%) due to cerebral infarction, and 30 procedures (8.9%) for other reasons. The surgical time needed for DC was 70.9±21 minutes (mean ± SD). Overall post-craniectomy complications included superficial wound healing disturbance (3.3%), abscess (2.7%) and CSF fistula (1.8%). Cranioplasty was performed 95±5 days after craniectomy. Cranioplasty was performed 170 times. Complications after cranioplasty included epidural hematoma (n=7), abscess (n=4), wound healing disturbance (n=11), and CSF fistula (n=2). Compared to literature data analyzing complication rates in patients undergoing DC with duroplasty, no significant differences could be found (superficial wound healing disturbance: 2.2%, abscess: 5–15%, and CSF fistula: 1.6–13% for the craniectomy procedure only). The surgical time needed for craniectomy with duroplasty was significantly longer when compared to our data (122.8±43 vs. 70.9±21 minutes).

Conclusions: The present data suggests that the omission of watertight duroplasty during craniectomy has no comprehensible disadvantages compared to craniectomy with additional dural expansion. It is easily performed and time saving.