Artikel
Complications and clinical outcome following cranioplasty in 97 patients
Suche in Medline nach
Autoren
Veröffentlicht: | 13. Mai 2014 |
---|
Gliederung
Text
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.