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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

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Intraoperative-moulded- vs. CAD-CAM-cranioplasty after decompressive craniectomy – a retrospective single-centre analysis of 258 cases with regard to perioperative modalities as well as short- and long-term complication rates and aesthetic results

Intraoperativ-geformte- vs. CAD-CAM-Kranioplastik nach dekompressiver Kraniektomie – eine retrospektive Single-Center-Analyse von 258 Fällen im Hinblick auf perioperative Modalitäten, sowie kurz- und langfristige Komplikationen und ästhetische Ergebnisse

Meeting Abstract

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  • presenting/speaker Dustin Hädrich - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Thomas Westermaier - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Andrea Cattaneo - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Almuth Friederike Keßler - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Ralf-Ingo Ernestus - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Paul Pakos - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Nadine Lilla - Universitätsklinikum Julius Maximilians Universität Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland; Universitätsklinikum Magdeburg, Neurochirurgische Klinik, Magdeburg, 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. DocP006

doi: 10.3205/21dgnc294, urn:nbn:de:0183-21dgnc2941

Veröffentlicht: 4. Juni 2021

© 2021 Hädrich 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: Cranioplasty (CP) after decompressive craniectomy (DC) restores the functionality and aesthetic of the patients cranial vault. Although it is a routine procedure, high complication rates have been described, partly related to the type of implant material used. Among many others, PMMA has been in clinical use for many years. It is available as intraoperative-molded (e.g. Palacos®) or computer-assisted/computer-manufactured (CAD-CAM) implants, which differ in the manufacturing and insertion process. We conducted this study to compare both implants in patients underwent DC with regard to perioperative modalities, short- and long-term complication rates and aesthetic results.

Methods: This retrospective single-center-analysis was conducted on 258 cases that underwent CP after DC. Palacos® patients (87/258) were observed from 01/2005-12/2012, whereas CAD-CAM patients (171/258) from 01/2010-12/2018 were included. Patients were followed based on medical, operative and digital records. Postoperative complications were divided into short-term (>30 days) and long-term (<30 days). Aesthetic results were evaluated via telephone interview.

Results: CAD-CAM patients had a significantly shorter surgery time (p < 0.001) and significantly lower intraoperative blood loss (p < 0.001) than Palacos® patients. Further surgical treatment after CP had to be carried out at 12.8% of patients. In the short term, the main reason for re-operation was epidural hematoma (6.2 %). Overall, Palacos® patients had significantly more implant dislocations (p < 0.05) compared to CAD-CAM. Implant infections occurred in 2.3% of Palacos® cases and 1.8% of CAD-CAM cases on the long-term view. Wound healing disorders occurred more frequently in CAD-CAM patients, which was associated with an increased number of previous operations. Regarding minor complications, Palacos® implants showed significantly more CSF pads (p < 0.05). Also, Palacos® leads to a significantly longer postoperative hospitalization (p < 0.005) than CAD-CAM. Although without statistical significance, CAD-CAM patients reported a better aesthetic result compared to Palacos® patients according to the results of our telephone interview.

Conclusion: This largest single-center-study on CP after DC shows superior peri- and postoperative results for CAD-CAM-implants compared to Palacos®. Further studies are needed to evaluate long-term complication rates, especially for CAD-CAM implants, and to increase the sample size to prove the observations in aesthetic results.