Complications following pediatric cranioplasty after decompressive craniectomy: a multicenter retrospective study
| Autor: | Dimitrios C Nikas, Nicholas M. Wetjen, Sean M. Lew, Christopher P Deibert, Stephanie Greene, Eric M. Thompson, Brandon G. Rocque, Bonita S. Agee, Kurtis I. Auguste, Lissa C. Baird, Bermans J. Iskandar, Taryn Bragg, Gerald A. Grant, Todd C. Hankinson, Michael Vassilyadi, Nathan R. Selden, Carrie R. Muh, Nalin Gupta, Mark P. Piedra, David M. Frim, Sandi Lam |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_treatment OR = odds ratio CI = confidence interval 0302 clinical medicine Postoperative Complications Risk Factors Child Pediatric Brain Diseases General Medicine Gastrostomy Cranioplasty Resorption trauma 030220 oncology & carcinogenesis Child Preschool cranioplasty Decompressive craniectomy Female Patient Safety bone resorption medicine.medical_specialty Decompressive Craniectomy Adolescent VP = ventriculoperitoneal complication Infections Bone resorption Head trauma Paediatrics and Reproductive Medicine 03 medical and health sciences medicine Humans Reconstructive Surgical Procedures Risk factor Bone Resorption Dental/Oral and Craniofacial Disease Preschool Retrospective Studies EVD = external ventricular drain Neurology & Neurosurgery business.industry Prevention Retrospective cohort study Plastic Surgery Procedures infection Surgery Brain Disorders Logistic Models Musculoskeletal business 030217 neurology & neurosurgery |
| Zdroj: | Rocque, BG; Agee, BS; Thompson, EM; Piedra, M; Baird, LC; Selden, NR; et al.(2018). Complications following pediatric cranioplasty after decompressive craniectomy: a multicenter retrospective study. JOURNAL OF NEUROSURGERY-PEDIATRICS, 22(3), 225-232. doi: 10.3171/2018.3.PEDS17234. UCSF: Retrieved from: http://www.escholarship.org/uc/item/4fs1k7r1 Journal of neurosurgery. Pediatrics, vol 22, iss 3 |
| DOI: | 10.3171/2018.3.PEDS17234. |
| Popis: | OBJECTIVEIn children, the repair of skull defects arising from decompressive craniectomy presents a unique set of challenges. Single-center studies have identified different risk factors for the common complications of cranioplasty resorption and infection. The goal of the present study was to determine the risk factors for bone resorption and infection after pediatric cranioplasty.METHODSThe authors conducted a multicenter retrospective case study that included all patients who underwent cranioplasty to correct a skull defect arising from a decompressive craniectomy at 13 centers between 2000 and 2011 and were less than 19 years old at the time of cranioplasty. Prior systematic review of the literature along with expert opinion guided the selection of variables to be collected. These included: indication for craniectomy; history of abusive head trauma; method of bone storage; method of bone fixation; use of drains; size of bone graft; presence of other implants, including ventriculoperitoneal (VP) shunt; presence of fluid collections; age at craniectomy; and time between craniectomy and cranioplasty.RESULTSA total of 359 patients met the inclusion criteria. The patients’ mean age was 8.4 years, and 51.5% were female. Thirty-eight cases (10.5%) were complicated by infection. In multivariate analysis, presence of a cranial implant (primarily VP shunt) (OR 2.41, 95% CI 1.17–4.98), presence of gastrostomy (OR 2.44, 95% CI 1.03–5.79), and ventilator dependence (OR 8.45, 95% CI 1.10–65.08) were significant risk factors for cranioplasty infection. No other variable was associated with infection.Of the 240 patients who underwent a cranioplasty with bone graft, 21.7% showed bone resorption significant enough to warrant repeat surgical intervention. The most important predictor of cranioplasty bone resorption was age at the time of cranioplasty. For every month of increased age the risk of bone flap resorption decreased by 1% (OR 0.99, 95% CI 0.98–0.99, p < 0.001). Other risk factors for resorption in multivariate models were the use of external ventricular drains and lumbar shunts.CONCLUSIONSThis is the largest study of pediatric cranioplasty outcomes performed to date. Analysis included variables found to be significant in previous retrospective reports. Presence of a cranial implant such as VP shunt is the most significant risk factor for cranioplasty infection, whereas younger age at cranioplasty is the dominant risk factor for bone resorption. |
| Databáze: | OpenAIRE |
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