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67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

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Cranioplasty after decompressive craniectomy: retrospective analysis of risk factors for complications and infection

Meeting Abstract

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  • Lukas Sveikata - Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
  • Amir El Rahal - Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
  • Martin Stienen - Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
  • Beatrice Leemann - Neurorehabilitation Division, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
  • Karl Schaller - Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
  • Andrea Bartoli - Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 129

doi: 10.3205/16dgnc504, urn:nbn:de:0183-16dgnc5045

Veröffentlicht: 8. Juni 2016

© 2016 Sveikata et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: Decompressive craniectomy due to intracranial hypertension is usually followed by a cranioplasty (CP). In our institution the delay to CP is 3 months. Although CP is a routine procedure, it is associated with significant rates of post-operative complications. The aim of our study was to analyze possible risk factors.

Method: We retrospectively collected demographic, clinical and radiological data of patients who underwent autologous or heterologous CP in our institution between 01/2007 - 12/2012 and were followed-up for more than 30 days post-operatively. The primary endpoint was presence of any complications associated with cranioplasty; in addition, infectious complications were separately analyzed (secondary endpoint).

Results: We identified 112 patients who underwent CP, of which 94 met the inclusion criteria. The mean delay to CP was 100.6 days (SD 90.5); mean craniectomy size 107.7cm2 (SD 39.6). Thirty-nine (41.5%) patients had at least one complication, of which 25 (26.6%) required surgical treatment. Sixteen infections (17.0%) resulted in 11 (11.7%) flap removals. More than two cranial surgeries before CP was a risk factor for overall complications (OR 4.4, CI 1.4-13.9, p=.007) and infection (OR 3.7, CI 1.1-12.1, p=.03). Time to CP was longer in patients with complications, including infectious (126.9 vs 93.9, p=.001). Complication rates did not differ between CP performed before/after 3 months delay post-craniectomy. In univariate analysis larger size of craniectomy (p<.001), longer duration of surgery (p=.02) and higher number of surgeries before CP (p=.04) were predictors of complication. In multivariate analysis only the latter remained an independent predictor of complication (p=.02).

Conclusions: Despite being a routine procedure CP carries a high rate of post-surgical complications. Our data suggests that 2 cranial surgeries or more before CP, larger craniectomy size and longer surgery time are risk factors for post-operative complications. More studies are needed to determine the optimal delay to cranioplasty.