Optimal Timing of Cranioplasty and Predictors of Overall Complications After Cranioplasty Brain Sunken Volume.xls

Background: The optimal timing of surgery and predictors of overall postoperative complications are still controversial. Objective: To determine the optimal timing of CP. Methods: Patients were divided into intervention group and control group based on brain sinking or not, respectively. Brain sunken volume was calculated by intracranial volume difference before and after CP in a 3-dimensional (3D) way. The main outcomes were overall complications and outcomes at 12-months follow-up after CP. Results: Of the 102 patients enrolled in this study, 56 patients in intervention group and 46 patients in control group. Complications were noted in 30.4% (n = 31), 24 (42.9%) patients in intervention group and 7 (15.2%) patients in control group, with a significant difference (P = 0.003). Thirty-three (58.9%) patients had good outcomes (mRS 0-3) in intervention group and 34 (73.9%) patients had good outcomes in control group, without a statistically significant difference (P = 0.113). Brain sinking (P = 0.005) and KPS score at the time of CP (P = 0.025) were significantly associated with overall postoperative complications. The cut-off value for brain sunken volume was determined as 11.26 cm3 in the ROC curve. The DC-CP interval was not related to brain sunken volume or postoperative complications. Conclusion: Brain sinking and lower KPS score at the time of CP were independent predictors of overall complications after CP. The optimal timing of CP may be determined by tissue window based on brain sunken volume instead of time window based on the DC-CP interval.背景：手术最佳时机与术后总体并发症的预测因素仍存在争议。目的：明确颅骨成形术（Cranioplasty, CP）的最佳时机。方法：根据是否存在脑下陷，将患者分别纳入干预组与对照组。采用三维（3D）成像方式计算CP手术前后的颅内体积差值，以此测算脑下陷体积。主要结局指标为术后总体并发症情况，以及CP术后12个月随访时的预后结果。结果：本研究共纳入102例患者，其中干预组56例，对照组46例。总体并发症发生率为30.4%（共31例）：干预组42.9%（24例）出现并发症，对照组为15.2%（7例），组间差异具有统计学意义（P=0.003）。干预组58.9%（33例）患者预后良好（改良Rankin量表（Modified Rankin Scale, mRS）评分0~3分），对照组为73.9%（34例），组间差异无统计学意义（P=0.113）。脑下陷（P=0.005）与CP手术时的卡氏功能状态评分（Karnofsky Performance Status, KPS）（P=0.025）均与术后总体并发症显著相关。经受试者工作特征（Receiver Operating Characteristic, ROC）曲线分析，脑下陷体积的最佳截断值确定为11.26 cm³。去骨瓣减压术-颅骨成形术间隔（DC-CP interval）与脑下陷体积及术后并发症均无相关性。结论：脑下陷与CP手术时较低的KPS评分是CP术后总体并发症的独立预测因素。CP的最佳手术时机或许可基于脑下陷体积构建组织窗来确定，而非依据去骨瓣减压术-颅骨成形术间隔时间构建的时间窗。