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Abstract：
Cranioplasty (CP) after decompressive hemicraniectomy (DHC) is a common neurosurgical procedure with a high complication rate. The best material for the repair of large cranial defects is unclear. The aim of this study was to evaluate different implant materials regarding surgery related complications after CP. Type of materials include the autologous bone flap (ABF), polymethylmethacrylate (PMMA), calcium phosphate reinforced with titanium mesh (CaP-Ti), polyetheretherketone (PEEK) and hydroxyapatite (HA). A retrospective, descriptive, observational bicenter study was performed, medical data of all patients who underwent CP after DHC between January 1st, 2016 and December 31st, 2022 were analyzed. Follow-up was until December 31st, 2023. 139 consecutive patients with a median age of 54 years who received either PMMA (56/139; 40.3%), PEEK (35/139; 25.2%), CaP-Ti (21/139; 15.1%), ABF (25/139; 18.0%) or HA (2/139; 1.4%) cranial implant after DHC were included in the study. Median time from DHC to CP was 117 days and median follow-up period was 43 months. Surgical site infection was the most frequent surgery-related complication (13.7%; 19/139). PEEK implants were mostly affected (28.6%; 10/35), followed by ABF (20%; 5/25), CaP-Ti implants (9.5%; 2/21) and PMMA implants (1.7%, 1/56). Explantation was necessary for 9 PEEK implants (25.7%; 9/35), 6 ABFs (24.0%; 6/25), 3 CaP-Ti implants (14.3%; 3/21) and 4 PMMA implants (7.1%; 4/56). Besides infection, a postoperative hematoma was the most common cause. Median surgical time was 106 min, neither longer surgical time nor use of anticoagulation were significantly related to higher infection rates (p = 0.547; p = 0.152 respectively). Ventriculoperitoneal shunt implantation prior to CP was noted in 33.8% (47/139) and not significantly associated with surgical related complications. Perioperative lumbar drainage, due to bulging brain, inserted in 38 patients (27.3%; 38/139) before surgery was protective when it comes to explantation of the implant (p = 0.035). Based on our results, CP is still related to a relatively high number of infections and further complications. Implant material seems to have a high effect on postoperative infections, since surgical time, anticoagulation therapy and hydrocephalus did not show a statistically significant effect on postoperative complications in this study. PEEK implants and ABFs seem to possess higher risk of postoperative infection. More biocompatible implants such as CaP-Ti might be beneficial. Further, prospective studies are necessary to answer this question.
摘要：
去骨瓣减压术（DHC）后的颅骨成形术（CP）是一种常见的神经外科手术，并发症发生率很高。修复大型颅骨缺损的最佳材料尚不清楚。这项研究的目的是评估不同的植入材料对CP后手术相关并发症的影响。材料类型包括自体骨瓣（ABF），聚甲基丙烯酸甲酯(PMMA),用钛网（CaP-Ti）增强的磷酸钙，聚醚醚酮(PEEK)和羟基磷灰石(HA)。回顾，描述性,描述性进行了双中心观察研究，1月1日期间所有在DHC后接受CP的患者的医疗数据，2016年12月31日,2022年进行了分析。随访一直持续到12月31日，2023年。139例接受PMMA治疗的患者，中位年龄为54岁（56/139；40.3%），PEEK（35/139；25.2％），CaP-Ti(21/139;15.1%),本研究包括DHC后的ABF(25/139;18.0%)或HA(2/139;1.4%)颅骨植入物。从DHC到CP的中位时间为117天，中位随访期为43个月。手术部位感染是最常见的手术相关并发症（13.7%；19/139）。PEEK植入物主要受到影响（28.6％；10/35），其次是ABF（20%；5/25），CaP-Ti植入物（9.5％；2/21）和PMMA植入物（1.7％，1/56）。对于9个PEEK植入物（25.7％；9/35），6ABF（24.0%；6/25），3个CaP-Ti植入物(14.3%;3/21)和4个PMMA植入物(7.1%;4/56)。除了感染,术后血肿是最常见的原因.手术时间中位数为106分钟,较长的手术时间和抗凝治疗与较高的感染率均不显著相关(p=0.547;p=0.152).在CP之前，脑室腹膜分流术的发生率为33.8％（47/139），与手术相关的并发症没有显着相关。围手术期腰椎引流,由于大脑膨胀，在手术前插入38例患者（27.3%;38/139），在植入植入物时具有保护性（p=0.035）。根据我们的结果,CP仍然与相对高数量的感染和进一步的并发症有关。植入物材料似乎对术后感染有很高的影响，从手术时间开始，在这项研究中，抗凝治疗和脑积水对术后并发症没有统计学意义。PEEK植入物和ABF似乎具有更高的术后感染风险。生物相容性更强的植入物如CaP-Ti可能是有益的。Further,前瞻性研究有必要回答这个问题。
