Objective: To compare the long-term outcomes of patients who had been randomly allocated to receive primary titanium cranioplasty or autologous bone graft following decompressive craniectomy. Methods: Sixty-four patients had been previously enrolled and randomised to receive either their own bone graft or a primary titanium cranioplasty. Functional and cosmetic outcomes had previously been assessed at 1-year following the cranioplasty procedure. Hospital records and the Picture Archiving communication system were reviewed to determine how many patients had cranioplasty failure or associated complications such as seizures beyond 1 year-with a minimum of 24-month follow-up. Results: Amongst the 31 patients in the titanium group (one patient had died), no patients had a partial or complete cranioplasty failure at 12 months follow-up and there had been no failures beyond 12 months. Amongst the 31 patients who had an autologous cranioplasty (one patient had died), 7 patients had complete resorption of the autologous bone such that it was adjudged a complete failure at 12-month follow-up. Five of these patients had had titanium augmentation and two patients declined further surgery. Both of these patients requested cranial augmentation for functional and cosmetic reasons subsequent to the 12-month follow-up. Another patient who had previously been noted to have moderate resorption at 12 months presented 1 year later with progressive bone flap resorption and also required subsequent augmentation for functional and cosmetic reasons. When follow-up was extended to a minimum of 24 months, use of titanium instead of autologous bone for primary cranioplasty resulted in a significant reduction in the number of patients who required rescue cranioplasty (0 vs 25%, 95% confidence interval [CI] 9.1-42.1%; p = 0.001). In addition, there were significantly less total hospital healthcare costs in those patients randomised to the titanium arm of the trial (difference = A$9999, 95%CI 2231-17,768; p = 0.015). Conclusions: Bone resorption continued to occur beyond 12 months after autologous cranioplasty; use of primary titanium cranioplasty after decompressive craniectomy reduced the number of reoperations needed and the associated long-term total hospital costs.

Autologous cranioplasty; Decompressive craniectomy; Randomised controlled trial; Titanium cranioplasty.

Stephen Honeybul, David Anthony Morrison, Kwok M Ho, Christopher R P Lind, Elizabeth Geelhoed

Department of Neurosurgery, Sir Charles Gairdner Hospital, 1 Hospital Avenue, Nedlands, Perth, WA, Australia. stephen.honeybul@health.wa.gov.au. Royal Perth Hospital, Wellington Street, Perth, WA, 6000, Australia. stephen.honeybul@health.wa.gov.au. Department of Medical Engineering and Physics, Royal Perth Hospital, Wellington Street, Perth, WA, 6000, Australia.

Acta Neurochir (Wien)

/

2018

自体颅骨

29546554

10.1007/s00701-018-3514-z