Artikel
Technical aspects of cranioplasty – first results of the German Cranial Reconstruction Registry (GCRR)
Technische Aspekte der kranioplastischen Operation – erste Ergebnisse des German Cranial Reconstruction Registry (GCRR)
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Autoren
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Julius Höhne
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
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Thomas Sauvigny
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Henrik Giese
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Jan Regelsberger
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Dirk Lindner
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Neurochirurgie, Leipzig, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
Text
Objective: Cranioplasty (CP) is common neurosurgical practice to repair a skull defect regardless of its etiology. There are different intraoperative standards for cranioplasty and the procedure had to adapt to a rapid technical evolution. The choice of material and surgical techniques is subject of ongoing debates. Here, we report the first interim analysis of the German Cranial Reconstruction Registry (GCRR) with regard to surgical techniques and choice of material used for CP.
Methods: A subgroup analysis of the GCRR, aprospective multicenter database for decompressive craniectomy and subsequent CP,was performed. All patients enrolled at the time of CP were included in the analysis.
Results: A total of 325 patients out of 351 registered in the GCRR were included. Autologous bone was used in 164 (54.0%) patients, computer-aided design/-manufacturing CAD/CAM CP in 122 (40.4%) and free-hand polymethylmethacrylate (PMMA) CP in 16 (5.3%). A mean of 6 (Range 1–24) prophylactic dural tenting sutures were used in 236 patients (75.2%). No intraoperative drain was placed in 24 (7.7%), 1 drain in 192 (61.3%) and 2 drains in 97 (31.0%) patients, respectively. Single-shot antibiotic prophylaxis was used in 313 (98.1%) procedures. Intraoperative reduction of cerebrospinal fluid (CSF) volume was necessary in 85 (26.7%); obtained by ventricular puncture in 62.2%, placement of a lumbar drain in 36.6% or puncture of the VP-Shunt pre-chamber in 1.2%. Hemorrhage or infarction was more frequently associated with lumbar drain placement (p=0.03) Regarding CP materials, at least one intraoperative complication occurred in 2,7% (8 patients) with autologous bone CP, 2,4% (7 patients) with CAD/CAM CP and no intraoperative complications with free-hand PMMA CP.
Conclusion: This multi-center analysis, for the first time, provides in-depth analysis of techniques, such as number of drains and dural tenting sutures as well as the materials utilized for CP. Upcoming analyses of the GCRR will further sharpen our understanding of this treatment.
