Artikel
Assessment of cranial defects after craniectomy: a proposal for classification
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Autoren
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Falko Schwarz
- Universitätsklinikum Jena, Klinik für Neurochirurgie, Jena, Deutschland
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Albrecht Waschke
- Universitätsklinikum Jena, Klinik für Neurochirurgie, Jena, Deutschland
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Michele Simon
- Vivantes Klinikum im Friedrichshain, Klinik für Neurochirurgie, Berlin, Deutschland
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Rolf Kalff
- Universitätsklinikum Jena, Klinik für Neurochirurgie, Jena, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: The assessment of cranial defects after craniectomy is a daily routine for neurosurgeons, not only in an intensive care unit setting. A classification to perform an objective grading is not implemented to date. The aim of our study was to categorize cranial defects after craniectomy and to devise a systematic comprehensible grading system for evaluation of these lesions.
Material and methods: The examiner stands behind the patient and assesses the defect by observing and palpation. Clinical data were differentiated in means of 12 easily comprehensible items, taking into account particularly resiliency and elevation in comparison to the cranial bone. Every assessment was carried out by two different examiners on a daily basis prospectively. Testing conditions e.g. position of the patient and location of the examiner were standardized. Additionally, every investigator was urged to estimate the degree of difficulty to assess the cranial defect on the basis of the selected items.
Results: A total of 200 examinations were conducted in 12 patients (8 men; median age 64 years). Most frequently craniotomy was performed by reason of an acute subdural hematoma (n=88; 44%). The mean extension regarding the cranial defect was 63.49 cm². 100 per cent of examination results coincided among the different investigators. In 95% (n=190) of cases the degree of difficulty to assess the cranial lesion was evaluated as simple. In 12 cases (6%) an increased degree of hardness was evaluated. In 2 out of 12 cases (16.7%) imaging was reapplied with surgical revision following. In 4 cases (33.3%) the gained degree in hardness was desired before autologous cranioplasty.
Conclusion: By means of our selected items a simple, reproducible and objective assessment and hence reliable monitoring of cranial defects is feasible. Due to the high reliability the classification of the cranial defect is also simple to assess for diverse examiners. In case of an alteration in the degree of hardness a fast adjustment of the currently conducted therapy seems therefore possible.
