Thomas Sauvigny1, Henrik Giese2, Julius Höhne3, Karl Michael Schebesch3, Christian Henker4, Andreas Strauss4, Kerim Beseoglu5, Niklas von Spreckelsen6, Jürgen A Hampl6, Jan Walter7,8, Christian Ewald7,9, Aleksandrs Krigers10, Ondra Petr10, Vicki M Butenschoen11, Sandro M Krieg11, Christina Wolfert12, Khaled Gaber13, Klaus Christian Mende1, Thomas Bruckner14, Oliver Sakowitz15, Dirk Lindner13, Jan Regelsberger1, Dorothee Mielke12. 1. 1Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. 2Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany. 3. 3Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany. 4. 4Department of Neurosurgery, University Hospital Rostock, Rostock, Germany. 5. 5Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. 6. 6Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. 7. 7Department of Neurosurgery, Jena University Hospital, Jena, Germany. 8. 8Department of Neurosurgery, Medical Center Saarbruecken, Saarbruecken, Germany. 9. 9Department of Neurosurgery, Brandenburg Medical School, Campus Brandenburg an der Havel, Germany. 10. 10Department of Neurosurgery, Medical University Innsbruck, Austria. 11. 11School of Medicine, Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany. 12. 12Department of Neurosurgery, Georg-August-University, Goettingen, Germany. 13. 13Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany. 14. 14Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany; and. 15. 15Department of Neurosurgery, Medical Center Ludwigsburg, Ludwigsburg, Germany.
Abstract
OBJECTIVE: Cranioplasty (CP) is a crucial procedure after decompressive craniectomy and has a significant impact on neurological improvement. Although CP is considered a standard neurosurgical procedure, inconsistent data on surgery-related complications after CP are available. To address this topic, the authors analyzed 502 patients in a prospective multicenter database (German Cranial Reconstruction Registry) with regard to early surgery-related complications. METHODS: Early complications within 30 days, medical history, mortality rates, and neurological outcome at discharge according to the modified Rankin Scale (mRS) were evaluated. The primary endpoint was death or surgical revision within the first 30 days after CP. Independent factors for the occurrence of complications with or without surgical revision were identified using a logistic regression model. RESULTS: Traumatic brain injury (TBI) and ischemic stroke were the most common underlying diagnoses that required CP. In 230 patients (45.8%), an autologous bone flap was utilized for CP; the most common engineered materials were titanium (80 patients [15.9%]), polyetheretherketone (57 [11.4%]), and polymethylmethacrylate (57 [11.4%]). Surgical revision was necessary in 45 patients (9.0%), and the overall mortality rate was 0.8% (4 patients). The cause of death was related to ischemia in 2 patients, diffuse intraparenchymal hemorrhage in 1 patient, and cardiac complications in 1 patient. The most frequent causes of surgical revision were epidural hematoma (40.0% of all revisions), new hydrocephalus (22.0%), and subdural hematoma (13.3%). Preoperatively increased mRS score (OR 1.46, 95% CI 1.08-1.97, p = 0.014) and American Society of Anesthesiologists Physical Status Classification System score (OR 2.89, 95% CI 1.42-5.89, p = 0.003) were independent predictors of surgical revision. Ischemic stroke, as the underlying diagnosis, was associated with a minor rate of revisions compared with TBI (OR 0.18, 95% CI 0.06-0.57, p = 0.004). CONCLUSIONS: The authors have presented class II evidence-based data on surgery-related complications after CP and have identified specific preexisting risk factors. These results may provide additional guidance for optimized treatment of these patients.
OBJECTIVE: Cranioplasty (CP) is a crucial procedure after decompressive craniectomy and has a significant impact on neurological improvement. Although CP is considered a standard neurosurgical procedure, inconsistent data on surgery-related complications after CP are available. To address this topic, the authors analyzed 502 patients in a prospective multicenter database (German Cranial Reconstruction Registry) with regard to early surgery-related complications. METHODS: Early complications within 30 days, medical history, mortality rates, and neurological outcome at discharge according to the modified Rankin Scale (mRS) were evaluated. The primary endpoint was death or surgical revision within the first 30 days after CP. Independent factors for the occurrence of complications with or without surgical revision were identified using a logistic regression model. RESULTS: Traumatic brain injury (TBI) and ischemic stroke were the most common underlying diagnoses that required CP. In 230 patients (45.8%), an autologous bone flap was utilized for CP; the most common engineered materials were titanium (80 patients [15.9%]), polyetheretherketone (57 [11.4%]), and polymethylmethacrylate (57 [11.4%]). Surgical revision was necessary in 45 patients (9.0%), and the overall mortality rate was 0.8% (4 patients). The cause of death was related to ischemia in 2 patients, diffuse intraparenchymal hemorrhage in 1 patient, and cardiac complications in 1 patient. The most frequent causes of surgical revision were epidural hematoma (40.0% of all revisions), new hydrocephalus (22.0%), and subdural hematoma (13.3%). Preoperatively increased mRS score (OR 1.46, 95% CI 1.08-1.97, p = 0.014) and American Society of Anesthesiologists Physical Status Classification System score (OR 2.89, 95% CI 1.42-5.89, p = 0.003) were independent predictors of surgical revision. Ischemic stroke, as the underlying diagnosis, was associated with a minor rate of revisions compared with TBI (OR 0.18, 95% CI 0.06-0.57, p = 0.004). CONCLUSIONS: The authors have presented class II evidence-based data on surgery-related complications after CP and have identified specific preexisting risk factors. These results may provide additional guidance for optimized treatment of these patients.