gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Article

Send article

Surgical repair of craniectomy defects – A retrospective analysis of 286 craniopasty procedures with different materials and techniques

Meeting Abstract

Search Medline for

  • Jakob Kraschl - Abteilung für Neurochirurgie, Klinikum Klagenfurt, Klagenfurt
  • Hannes Rauter - Abteilung für Neurochirurgie, Klinikum Klagenfurt, Klagenfurt
  • Eberhard Uhl - Klinik für Neurochirurgie der Justus Liebig Universität Gießen, Gießen
  • Giles Hamilton Vince - Abteilung für Neurochirurgie, Klinikum Klagenfurt, Klagenfurt

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.04.09

doi: 10.3205/14dgnc297, urn:nbn:de:0183-14dgnc2975

Published: May 13, 2014

© 2014 Kraschl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Decompressive craniectomy is an established method for decreasing intracranial pressure in cases of severe cerebral swelling. This study examines different surgical materials and techniques of repair with regard to inherent cost and surgical risk with a particular focus on infectious complications.

Method: A retrospective analysis was conducted of 296 patients who underwent decompressive craniectomy at our institution between january 2003 and june 2013. Cranioplasty was performed in 286 cases using autologous bone graft in 200, freehand modeled acrylic graft in 73 and industrial PSI acrylic implant in 13 cases. Median follow-up was 43,3 months. 59 patients were additionally treated with a ventricular-peritoneal shunt, 8 of which were performed together with cranioplasty, 51 in a second operation.

Results: In 21% of cases (n= 62) reoperation became necessary for reasons of dislocation, hemorrhage or infection. 20% of the autologous bone grafts, 13% of freehand acrylic and 15% of PSI grafts required revision. Within the follow-up period infectious complications were seen in 8% in all 3 groups. In 48% (n= 18) MR revealed airless paranasal sinuses or mucosal thickening on the trephined side, however microbiological work-up revealed Stapylococcus areus as the main pathogen. The risk of infection showed a tendency to increase when cranioplasty was combined with ventriculoperitoneal shunting (2/8 versus 8/51).

Conclusions: Cranioplasty can be safely performed using all three examined techniques. The rates of infectious complications are comparable between groups. Concomittant VP-shunting shows a tendency towards an increase of infectious complications. Autologous bone grafts are simple to perform and cost effective.