Surface Area of Decompressive Craniectomy Predicts Bone Flap Failure after Autologous Cranioplasty: A Radiographic Cohort Study.

Autor:	Johnson WC; Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA., Ravindra VM; Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California, USA.; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA., Fielder T; Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA., Ishaque M; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA., Patterson TT; Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA., McGinity MJ; Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA., Lacci JV; Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA., Grandhi R; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Jazyk:	angličtina
Zdroj:	Neurotrauma reports [Neurotrauma Rep] 2021 Aug 27; Vol. 2 (1), pp. 391-398. Date of Electronic Publication: 2021 Aug 27 (Print Publication: 2021).
DOI:	10.1089/neur.2021.0015
Abstrakt:	Skull bone graft failure is a potential complication of autologous cranioplasty after decompressive craniectomy (DC). Our objective was to investigate the association of graft size with subsequent bone graft failure after autologous cranioplasty. This single-center retrospective cohort study included patients age ≥18 years who underwent primary autologous cranioplasty between 2010 and 2017. The primary outcome was bone flap failure requiring graft removal. Demographic, clinical, and radiographic factors were recorded; three-dimensional (3D) reconstructive imaging was used to perform accurate measurements. Univariate and multi-variate regression analysis were performed to identify risk factors for the primary outcome. Of the 131 patients who underwent primary autologous cranioplasty, 25 (19.0%) underwent removal of the graft after identification of bone flap necrosis on computed tomography (CT); 16 (64%) of these were culture positive. The mean surface area of craniectomy defect was 128.5 cm 2 for patients with bone necrosis and 114.9 cm 2 for those without bone necrosis. Linear regression analysis demonstrated that size of craniectomy defect was independently associated with subsequent bone flap failure; logistic regression analysis demonstrated a defect area >125 cm 2 was independently associated with failure (odds ratio [OR] 3.29; confidence interval [CI]: 0.249-2.135). Patient- and operation-specific variables were not significant predictors of bone necrosis. Our results showed that increased size of antecedent DC is an independent risk factor for bone flap failure after autologous cranioplasty. Given these findings, clinicians should consider the increased potential of bone flap failure after autologous cranioplasty among patients whose initial DC was >125 cm 2 . Competing Interests: No conflicting financial interests exist.
Databáze:	MEDLINE
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