成人颅骨修补术后并发症及其防治策略

doi:10.3877/cma.j.issn.2095-9141.2023.02.008

目的

分析成人颅骨修补术后并发症的类型及其防治策略。

方法

回顾性分析联勤保障部队第九四〇医院神经外科自2017年1月至2022年2月行颅骨修补术后发生并发症的40例患者的临床资料，研究颅骨修补术后并发症的类型及原因，结合相关文献分析探讨诊疗策略。

结果

颅骨修补术后，8例患者发生硬膜外血肿，1例患者发生脑挫裂伤并血肿，9例患者发生感染，2例患者随访发生局部颞肌的萎缩，4例患者随访发生感染修补材料外露，15例患者发生癫痫，临床给予相应治疗后均治愈出院，其中1例患者发生反常性脑疝死亡。

结论

颅骨修补术后并发症包括皮肤及皮下感染、修补材料外露、颅内出血、癫痫、反常性脑疝等，临床医生需要制订个性化的诊疗策略，以降低修补术后并发症的发生率。

关键词: 颅骨修补术, 成人, 并发症, 策略

Objective

To analyze the types of complications after cranioplasty in adults and their prevention and treatment strategies.

Methods

The clinical data of 40 patients with complications after cranioplasty in Neurosurgery Department of the 940^th Hospital of Joint Logistics Support Force of PLA from January 2017 to February 2022 were retrospectively analyzed. The types and causes of complications after cranioplasty were analyzed, and the diagnosis and treatment strategies were discussed based on the analysis of relevant literature.

Results

After cranioplasty, epidural hematoma occurred in 8 patients, cerebral contusion and hematoma occurred in 1 patient, infection occurred in 9 patients, atrophy of local temporalis muscle occurred in 2 patients, exposure of infected repair material occurred in 4 patients, epilepsy occurred in 15 patients after surgery. After receiving corresponding clinical treatment, all patients were cured and discharged. Among them, 1 patient died of paradoxical brain herniation after surgery.

Conclusion

The postoperative complications of cranial repair include skin and subcutaneous infection, exposure of repair material, intracranial hemorrhage, epilepsy, and paradoxical brain herniation, etc. Clinicians need to develop individualized treatment strategies to reduce the incidence of postoperative complications.

Key words: Cranioplasty, Adult, Complications, Strategies

[1]	李长栋,周杰,蔡志标,等.异甘草素对大鼠脑损伤后MMP-9和TIMP-1蛋白酶表达的影响[J].中华神经创伤外科电子杂志, 2021, 7(4): 199-202. DOI: 10.3877/ema.j.issn.2095-9141.2021.04.002.
[2]	Hanko M, Cmarkova K, Hanzel R, et al. Analysis of clinical efficiency and early postoperative complications after cranioplasty[J]. Bratisl Lek Listy, 2021, 122(7): 461-468. DOI: 10.4149/BLL_2021_076.
[3]	片山容一,佐野公俊,久保田紀彦,等.神经外科专科医师必修手术[M].沈阳:辽宁科学出版社, 2018: 52-55.
[4]	王一明,杨凤东,毛文斌,等.颅骨修补材料三维数字化塑形聚醚醚酮、钛网临床应用优势的比较[J].中国组织工程研究, 2022, 26(34): 5492-5497. DOI: 10.12307/2022.461.
[5]	王金艳,王丽娜.颅脑损伤患者去骨瓣减压术后发生脑水肿的影响因素[J].河南医学研究, 2022, 31(18): 3301-3303. DOI: 10.3969/j.issn.1004-437X.2022.18.010.
[6]	Shepetovsky D, Mezzini G, Magrassi L. Complications of cranioplasty in relationship to traumatic brain injury: a systematic review and meta-analysis[J]. Neurosurg Rev, 2021, 44(6): 3125-3142. DOI: 10.1007/s10143-021-01511-7.
[7]	方新运,陈三送,狄广福,等.颅骨修补手术方式的选择[J].齐齐哈尔医学院学报, 2019, 40(7): 820-822. DOI: 10.3969/j.issn.1002-1256.2019.07.011.
[8]	李长栋,蔡志标,周杰,等.反常性脑疝3例报道及文献复习[J].中国临床神经外科杂志, 2022, 27(5): 384-387. DOI: 10.13798/j.issn.1009-153X.2022.05.016.
[9]	梁松林,荔志云,孙建军,等.颅骨修补术后并发症及其影响因素分析[J].中华神经创伤外科电子杂志, 2021, 7(6): 350-354. DOI: 10.3877/cma.j.issn.2095-9141.2021.06.006.
[10]	Goedemans T, Verbaan D, van der Veer O, et al. Complications in cranioplasty after decompressive craniectomy: timing of the intervention[J]. J Neurol, 2020, 267(5): 1312-1320. DOI: 10.1007/s00415-020-09695-6.
[11]	Roh H, Kim J, Kim JH, et al. Analysis of complications after cranioplasty with a customized three-dimensional titanium mesh plate[J]. World Neurosurg, 2019, 123: e39-e44. DOI: 10.1016/j.wneu.2018.10.227.
[12]	Yao S, Zhang Q, Mai Y, et al. Outcome and risk factors of complications after cranioplasty with polyetheretherketone and titanium mesh: a single-center retrospective study[J]. Front Neurol, 2022, 13: 926436. DOI: 10.3389/fneur.2022.926436.
[13]	Tsianaka E, Drosos E, Singh A, et al. Post-cranioplasty complications: lessons from a prospective study assessing risk factors[J]. J Craniofac Surg, 2021, 32(2): 530-534. DOI: 10.1097/SCS.0000000000007344.
[14]	Chen JH, Zhang W, Shi ZH, et al. Infections under skin flap after cranioplasty and a simple effective treatment[J]. Turk Neurosurg, 2020, 30(6): 808-812. DOI: 10.5137/1019-5149.JTN.22011-17.2.
[15]	Missori P, Currà A, Peschillo S, et al. Intracerebral hemorrhage after cranioplasty: an unpredictable treacherous complication due to reperfusion or possible systemic inflammatory response syndrome[J]. Neurol Sci, 2018, 39(5): 959-960. DOI: 10.1007/s10072-017-3225-x.
[16]	Peng A, Qi W, Cao D, et al. Fibrinolytic therapy improves outcomes in patients with epidural hematomas following cranioplasty: a pilot study[J]. J Neurol Surg A Cent Eur Neurosurg, 2018, 79(1): 39-44. DOI: 10.1055/s-0037-1606848.
[17]	Hirschmann D, Kranawetter B, Tomschik M, et al. New-onset seizures after cranioplasty-a different view on a putatively frequently observed phenomenon[J]. Acta Neurochir (Wien), 2021, 163(5): 1437-1442. DOI: 10.1007/s00701-021-04720-7.
[18]	Wang H, Zhang K, Cao H, et al. Seizure after cranioplasty: incidence and risk factors[J]. J Craniofac Surg, 2017, 28(6): e560-e564. DOI: 10.1097/SCS.0000000000003863.
[19]	Shih FY, Lin CC, Wang HC, et al. Risk factors for seizures after cranioplasty[J]. Seizure, 2019, 66: 15-21. DOI: 10.1016/j.seizure.2018.12.016.
[20]	Chen CC, Yeap MC, Liu ZH, et al. A novel protocol to reduce early seizures after cranioplasty: a single-center experience[J]. World Neurosurg, 2019, 125: e282-e288. DOI: 10.1016/j.wneu.2019.01.062.
[21]	Brandicourt P, Delanoé F, Roux FE, et al. Reconstruction of cranial vault defect with polyetheretherketone implants[J]. World Neurosurg, 2017, 105: 783-789. DOI: 10.1016/j.wneu.2017.04.049.
[22]	王鹏,王志明,刘福增,等.改良式翻皮技巧对颞肌下颅骨修补术中颞肌功能的保护作用[J].局解手术学杂志, 2021, 30(7): 612-615. DOI:10.11659/jjssx.01E021021.
[23]	Robles LA, Cuevas-Solórzano A. Massive brain swelling and death after cranioplasty: a systematic review[J]. World Neurosurg, 2018, 111: 99-108. DOI: 10.1016/j.wneu.2017.12.061.
[24]	Zhang X, Pan B, Ye Z, et al. Massive brain swelling after cranioplasty: a case report[J]. J Neurol Surg A Cent Eur Neurosurg, 2019, 80(6): 498-502. DOI: 10.1055/s-0039-1688726.
[25]	Shen L, Zhou Y, Xu J, et al. Malignant cerebral swelling after cranioplasty: case report and literature review[J]. World Neurosurg, 2018, 110: 4-10. DOI: 10.1016/j.wneu.2017.10.102.

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Postoperative complications and treatment strategies after cranioplasty in adults

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Postoperative complications and treatment strategies after cranioplasty in adults