gms | German Medical Science

65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. - 14. Mai 2014, Dresden

Complications and clinical outcome following cranioplasty in 97 patients

Meeting Abstract

  • Friederike Fritzsche - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Jennifer Göttsche - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Thomas Sauvigny - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Manfred Westphal - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Jan Regelsberger - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 115

doi: 10.3205/14dgnc511, urn:nbn:de:0183-14dgnc5112

Veröffentlicht: 13. Mai 2014

© 2014 Fritzsche 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

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Objective: To point out the clinical outcome (GOS) and complications in patients with decompressive hemicraniectomy (DC) who underwent cranioplastic surgery (CS) with/without ventriculoperitoneal shunting and who were eligible for further follow-up.

Method: Clinical data of 173 patients with decompressive hemicraniectomies (DC) due to subarachnoid hemorrhage (SAH), traumatic brain injury (TBI) and media infarction (MI) were analyzed. 70 patients with DC died due to their primary disease and 97 patients with CS were included in the study: 34 cases of TBI (35%), 40 cases of MI (41.2%), 9 cases of aneurysmal SAH (9.2%) and 14 cases of severe brain edema of other reasons (14.4%).

Results: There were 56 males (57.7%) and 41 females (42.3%). Mean age at CS was 46.7 yrs. Mean interval from DC to CS was 146 days. The primary implant was autologous bone in 88 cases (90.7%) followed by PEEK-CAD in 3 cases (3.1%), titanium-CAD in 2 cases (2%), PMMA in 2 cases (2%), ceramic-CAD in 1 case (1%) and acryl-CAD in 1 case (1%). Complications requiring surgical revision appeared in 18.6% with a mean follow-up of 30 months. There were intracranial bleedings in 5 cases (5.1%), aseptic bone necrosis in 8 cases (8.3%) and infections in 2 cases (2%). 8 patients needed re-surgery with PEEK-CAD implant (8.3%). Mean GOS at primary CS was 3.5 and increased to 3.7 after 30 months finishing rehabilitation. Best long-term outcome was seen in TBI-patients (GOS of 4.3), followed by SAH-patients (GOS 3.8) and the MI group (GOS 3.2). While clinical outcome improved over time, patients without shunt surgery were significantly better compared to the group with shunting (GOS 3.7 vs. GOS 2.9; p<0.001). Overall, 25 patients (25.8%) got shunt dependent of which 10 had TBI (29.4% of all TBI), 6 suffered from MI (15% of all MI), 6 had SAH (66.7% of all SAH) and 3 other patients (21.4% of all others).

Conclusions: CS is accompanied with a 20% complication rate in which intracranial bleedings and bone necrosis are of major concern. 25% of patients with CS get shunt dependent, which is equivalent to a far worse clinical course. Even all patients improve over time remarkable, targeted rehabilitation programmes lasting for at least 15-20 months turned out to be determining the long-term result.