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Complications following cranioplasty using autologous bone or polymethylmethacrylate-Retrospective experience from a single center
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
2013 (Engelska)Ingår i: Clinical neurology and neurosurgery (Dutch-Flemish ed. Print), ISSN 0303-8467, E-ISSN 1872-6968, Vol. 115, nr 9, s. 1788-1791Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: A decompressive hemicraniectomy is a potentially life-saving intervention following head trauma. Once performed patients are obliged to undergo a second procedure with cranioplasty. Two of the most commonly used materials are autologous bone and polymethylmethacrylate (PMMA). We have now evaluated complications following a cranioplasty using these materials. Materials and methods: During a 7-year period (2002-2008) 49 patients were operated with a decompressive craniectomy following head trauma. Patients received a cranioplasty consisting of autologous bone (30 patients, 61.2%) or PMMA (19 patients, 38.8%) and were followed at least 24 months. Patient data were collected retrospectively. Results: Twenty patients (20/49, 40.8%) experienced a complication that prompted a re-operation. There was a significantly higher rate of complications leading to a re-operation (53.3% vs. 21.1%, p = 0.03) and a shorter survival time of the cranioplasty (mean 48.1 +/- 7.8 vs. 79.5 +/- 9.0 months, p = 0.035) in patients with autologous bone compared to PMMA. Bone resorption and the presence of postoperative hematomas were significantly more common in patients with autologous bone. The material used for cranioplasty was the only variable that significantly correlated to the rate of complications. Conclusions: In our series we had a high percentage of patients needing re-operation due to complications following a cranioplasty. Though generally considered a straightforward procedure, complications and associated morbidity in patients undergoing cranioplasty should not be underestimated. 

Ort, förlag, år, upplaga, sidor
2013. Vol. 115, nr 9, s. 1788-1791
Nyckelord [en]
Decompressive hemicraniectomy, Cranioplasty, Autologous bone, Polymethylmethacrylate, Complications
Nationell ämneskategori
Neurologi
Identifikatorer
URN: urn:nbn:se:umu:diva-82299DOI: 10.1016/j.clineuro.2013.04.013ISI: 000324787900039OAI: oai:DiVA.org:umu-82299DiVA, id: diva2:668765
Tillgänglig från: 2013-12-02 Skapad: 2013-10-29 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. On evolution of intracranial changes after severe traumatic brain injury and its impact on clinical outcome
Öppna denna publikation i ny flik eller fönster >>On evolution of intracranial changes after severe traumatic brain injury and its impact on clinical outcome
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Severe traumatic brain injury (sTBI) is a cause of death and disability worldwide and requires treatment at specialized neuro-intensive care units (NICU) with a multimodal monitoring approach. The CT scan imaging supports the monitoring and diagnostics. The level of S100B and neuron specific enolase (NSE) reflects the severity of the injury. The therapy resistant intracranial hypertension requires decompressive craniectomy (DC). After DC, the cranium must be reconstructed to recreate the normal intracranial physiology as well as to address cosmetic issues. The evolution of the pathological intracranial changes was analyzed in accordance with the three CT classifications: Marshall, Rotterdam and Morris-Marshall. The Rotterdam scale was best in describing the dynamics of the pathological evolution. Both the Rotterdam score and Morris- Marshall classification showed strong correlation with the clinical outcome, a finding that suggests that they could be used for prognostication. We demonstrated a clear correlation between the CT classifications and concentrations of S100B and NSE. The results revealed a concomitant correlation between NSE and S100B and clinical outcome. We found that the interaction between the ICP, Rotterdam CT classification, and concentrations of biochemical biomarkers are all associated with DC. We found a high percentage of complications following cranioplasty. Our results call into question whether custom-made allograft should be considered the best material for cranioplasty. It is concluded that both the Rotterdam and Morris-Marshall classification contribute to clinical evaluation of intracranial dynamics after sTBI, and might be used in combination with biochemical biomarkers for better assessment. The decision to perform DC should include a re-assesment of ICP evolution, CT scan images and concentration of the biochemical biomarkers. Furthermore, when determining whether DC treatment should be used, surgeon should also consider the risks of the following cranioplasty.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2016. s. 134
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1836
Nyckelord
Severe traumatic brain injury, ICP targeted therapy, ICP, decompressive craniectomy, S100B, NSE, cranioplasty
Nationell ämneskategori
Annan medicin och hälsovetenskap Neurologi
Forskningsämne
neurokirurgi
Identifikatorer
urn:nbn:se:umu:diva-124069 (URN)978-91-7601-442-4 (ISBN)
Disputation
2016-09-02, Sal E04, byggnad 6A, Norrlands Universitetssjukhus, Umeå, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2016-08-18 Skapad: 2016-07-11 Senast uppdaterad: 2018-06-07Bibliografiskt granskad

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Bobinski, LukasKoskinen, Lars-Owe D.Lindvall, Peter

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Totalt: 281 träffar
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