Artikel
Is there a future for decompressive craniectomy? Results of the German Cranial Reconstruction Registry (GCRR)
Gibt es eine Zukunft für die dekompressive Kraniektomie? Ergebnisse des German Cranial Reconstruction Registry (GCRR)
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Autoren
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Henrik Giese
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Thomas Sauvigny
- Ev.-Luth. Diakonissenanstalt zu Flensburg, Klinik für Neurochirurgie, Flensburg, Deutschland
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Julius Höhne
- Universitätsklinikum Regensburg, Neurochirurgische Klinik, Regensburg, Deutschland
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Dirk Lindner
- Universitätsklinikum Leipzig, Neurochirurgische Klinik, Leipzig, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Jan Regelsberger
- Ev.-Luth. Diakonissenanstalt zu Flensburg, Klinik für Neurochirurgie, Flensburg, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
Text
Objective: The benefit of decompressive craniectomy (DC) in cerebral infarction (CI) and traumatic brain injury (TBI) is an ongoing debate in which the aspect of a reduced mortality seems to ignore the procedural complication rate accompanied by clinical disability. Here, we report an interim analysis of the German Cranial Reconstruction Registry (GCRR) with special regard to the timing and technique of DC and perioperative complications.
Methods: A subgroup analysis of the GCRR, a prospective multicenter database for DC and subsequent cranioplasty,was performed. All patients enrolled at the time of DC were included in the analysis and perioperative complications as well as in-hospital neurologic outcome were analyzed.
Results: A total of 217 patients out of 502 registered in the GCRR were included. Depending on the diagnosis we divided five groups: 1. TBI (37.6%), 2. Malignant CI (25.2%), 3. aneurismatic Subarachnoid Hemorrhage (aSAH, 12.8%), 4. Intracerebral Hemorrhage (ICH, 7.8%) and 5. Other (16.5%). Patients in group 2 and 4 showed a significant worse neurological outcome (mRs 4.7±0.4 and 4.63±0.9) at discharge compared to patients in group 1 (mRs 2.8±4) or 5 (1.5±2.7). In addition, size of DC were different between the five groups with significant larger DC’s in group 1 and 2. The overall in-hospital mortality rate was 12.4% whereas the overall complication rate after DC was 40.6% (88/217 patients). Most common complications were wound healing disorders (23.5%), CSF-fistulas (12.2%) and postoperative hemorrhage (6.8%). A revision surgery was necessary in 31.3% of patients.
Conclusion: High complication rates of more than 40% require a critical reevaluation of previous DC studies and call our daily management into question. Upcoming analyses of the GCRR will further sharpen our understanding of this treatment.
