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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Development of aseptic bone flap necrosis after autologous cranioplasty based on CT-scan analysis

Entwicklung der aseptischen Knochennekrose nach autologer Kranioplastik anhand einer computertomographisch-basierten Analyse

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Sophie Kubon - Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland
  • Christian Senft - Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland
  • Falko Schwarz - Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV050

doi: 10.3205/21dgnc052, urn:nbn:de:0183-21dgnc0526

Veröffentlicht: 4. Juni 2021

© 2021 Kubon 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: Aseptic bone necrosis is still a common long-term complication after bone flap reinsertion following initial decompressive craniectomy. Aim of the study was to monitor the structural changes of the bone flap after cranioplasty as well as to determine the impact of an additional liquor shunt.

Methods: Thirty-four (22 male, 12 female) patients, who received a cranioplasty between September 2004 and April 2010, have been included. The medium age was 47 years at the time of cranioplasty. Reasons for the initial craniectomy were a subarachnoid haemorrhage (n = 10), a subdural or epidural haemorrhage (n = 11), a malignant cerebral infarction (n = 11) and an intracerebral haemorrhage (n=2).

We retrospectively analysed the first post-operative and follow-up CT scans and measured the bone density in Hounsfield units (HU), bone thickness (measurement at different defined points), the development of a bone bridge and a modification of the Lakshmanan score based on the trabecular pattern (Figure 1 [Fig. 1]). The median follow-up was 44 months.

Results: A significant loss of bone density with an average decline of 22.5 % (p<0.001) occurred in 29 patients (85.3%). Decline of bone density within the first 6 months was statistically relevant with a mean decrease from 1066 HU to 900 HU (p<0.001). 31 patients (91.2%) had a decrease in the bone thickness with an average loss of 1,62 mm. A decrease of the trabecular pattern was noticed in 24 (70.6%) patients. In 12 cases (35.3 %; 6 with shunt (17.7%), 6 without (17.7%) a surgery caused by the aseptic necrosis was indicated. Patients with a ventriculoperitoneal shunt (WS) had a slightly higher bone density than those without shunt (WOS), (WS: 886.07 HU; WOS: 800.84 HU, p = 0.488).

Conclusion: Decline in bone density and bone thickness were common observations in this study. The decrease seems to be relevant especially in the first 6 months. For this reason, patients should be monitored particularly closely during this time. Further patients should be analysed to investigate, whether there is a significant difference between patients with or without a ventriculoperitoneal shunt.