Cranioplasty with hydroxyapatite or acrylic is associated with a reduced risk of all-cause and infection-associated explantation.

Autor: Millward CP; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.; Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom., Doherty JA; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom., Mustafa MA; School of Medicine, University of Liverpool, Liverpool, United Kingdom., Humphries TJ; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom., Islim AI; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.; Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom.; School of Medicine, University of Liverpool, Liverpool, United Kingdom., Richardson GE; School of Medicine, University of Liverpool, Liverpool, United Kingdom., Clynch AL; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.; Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom.; School of Medicine, University of Liverpool, Liverpool, United Kingdom., Gillespie CS; School of Medicine, University of Liverpool, Liverpool, United Kingdom., Keshwara SM; School of Medicine, University of Liverpool, Liverpool, United Kingdom., Kolamunnage-Dona R; Institute of Population Health, University of Liverpool, Liverpool, United Kingdom., Brodbelt AR; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.; Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom., Jenkinson MD; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.; Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom., Duncan C; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom., Sinha A; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom., McMahon CJ; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
Jazyk: angličtina
Zdroj: British journal of neurosurgery [Br J Neurosurg] 2022 Jun; Vol. 36 (3), pp. 385-393. Date of Electronic Publication: 2022 May 24.
DOI: 10.1080/02688697.2022.2077311
Abstrakt: Objective: Cranioplasty remains an essential procedure following craniectomy but is associated with high morbidity. We investigated factors associated with outcomes following first alloplastic cranioplasty.
Methods: A single-centre, retrospective cohort study of patients undergoing first alloplastic cranioplasty at a tertiary neuroscience centre (01 March 2010-01 September 2021). Patient demographics and craniectomy/cranioplasty details were extracted. Primary outcome was all-cause explantation. Secondary outcomes were explantation secondary to infection, surgical morbidity and mortality. Multivariable analysis was performed using Cox proportional hazards regression or binary logistic regression.
Results: Included were 287 patients with a mean age of 42.9 years [SD = 15.4] at time of cranioplasty. The most common indication for craniectomy was traumatic brain injury (32.1%, n = 92). Cranioplasty materials included titanium plate (23.3%, n = 67), hydroxyapatite (22.3%, n = 64), acrylic (20.6%, n = 59), titanium mesh (19.2%, n = 55), hand-moulded PMMA cement (9.1%, n = 26) and PEEK (5.6%, n = 16). Median follow-up time after cranioplasty was 86.5 months (IQR 44.6-111.3). All-cause explantation was 12.2% (n = 35). Eighty-three patients (28.9%) had surgical morbidity. In multivariable analysis, the risk of all-cause explantation and explantation due to infection was reduced with the use of both hydroxyapatite (HR 0.22 [95% CI 0.07-0.71], p  = .011, HR 0.22 [95% CI 0.05-0.93], p  = .040) and acrylic (HR 0.20 [95% CI 0.06-0.73], p  = .015, HR 0.24 [95% CI 0.06-0.97], p  = .045), respectively. In addition, risk of explantation due to infection was increased when time to cranioplasty was between three and six months (HR 6.38 [95% CI 1.35-30.19], p  = .020). Mean age at cranioplasty (HR 1.47 [95% CI 1.03-2.11], p  = .034), titanium mesh (HR 5.36 [95% CI 1.88-15.24], p  = .002), and use of a drain (HR 3.37 [95% CI 1.51-7.51], p  = .003) increased risk of mortality.
Conclusions: Morbidity is high following cranioplasty, with over a tenth requiring explantation. Hydroxyapatite and acrylic were associated with reduced risk of all-cause explantation and explantation due to infection. Cranioplasty insertion at three to six months was associated with increased risk of explantation due to infection.
Databáze: MEDLINE
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