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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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Risk score for early identification of individuals at risk for aseptic bone flap necrosis

Risiko-Score zur Früherkennung von Patienten mit einem Risiko für eine aseptische Knochendeckelnekrose

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  • presenting/speaker Lennart Barthel - University Hospital Essen, Department of Neurosurgery, Essen, Deutschland
  • Susann Hetze - University Hospital Essen, Department of Neurosurgery, Essen, Deutschland
  • Marvin Darkwah Oppong - University Hospital Essen, Department of Neurosurgery, Essen, Deutschland
  • Mehdi Chihi - University Hospital Essen, Department of Neurosurgery, Essen, Deutschland
  • Daniela Pierscianek - University Hospital Essen, Department of Neurosurgery, Essen, Deutschland
  • Philipp Dammann - University Hospital Essen, Department of Neurosurgery, Essen, Deutschland
  • Karsten Henning Wrede - University Hospital Essen, Department of Neurosurgery, Essen, Deutschland
  • Ulrich Sure - University Hospital Essen, Department of Neurosurgery, Essen, Deutschland
  • Ramazan Jabbarli - University Hospital Essen, Department of Neurosurgery, Essen, 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. DocP208

doi: 10.3205/21dgnc489, urn:nbn:de:0183-21dgnc4899

Published: June 4, 2021

© 2021 Barthel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Aseptic bone flap necrosis (ABFN) is a common complication of autologous cranioplasty, necessitating a re-operation. Therefore, ABFN-prone individuals might be more eligible for direct cranioplasty using artificial bone flap implants. The aim of this work was to identify relevant demographic, clinical and laboratory markers of ABFN in a large cohort, in order to develop a risk score for ABFN occurrence.

Methods: All patients who underwent autologous cranioplasty after decompressive surgery between 2007 and 2019 were included. Laboratory data, initial clinical diagnosis and demographic parameters were identified that were retrievable at the time prior to craniectomy and prior autologous bone flap reimplantation. Univariant and multivariant analysis were carried out for the surveyed variables. Significant predictors of the multivariate analysis were used to determine the score.

Results: Of 412 patients that underwent craniectomy, 58 individuals (14% [32 female: 55.2%]) developed ABFN. The following independent predictors of ABFN were included in the risk score (0-6 points): craniectomy due to trauma or hemorrhagic stroke (2 points), younger age (< 40 years, 2 points), cranioplasty timing (> 94 days, 1 point) and an Alanin-Aminotransferase (ALT) < 18 U/L (1 point). The rates of ABFN in the patients scoring 0-2, 3-4 and 5-6 points were 4.2%, 16.1% and 34.6% respectively. The risk score showed a moderate diagnostic accuracy for ABFN prediction (area under the curve: 0.717).

Conclusion: We could identify independent predictors of ABFN, which were summarized in a risk score. The data indicate that future studies should focus on the value of metabolic syndromes in the occurrence of ABFN.