Dokument: Frühe Nachblutungen nach Kranioplastiken - eine retrospektive Analyse

Titel:

Frühe Nachblutungen nach Kranioplastiken - eine retrospektive Analyse

Weiterer Titel:

Early Postoperative Hemorrhage After Cranioplasty – A Retrospective Analysis

URL für Lesezeichen:

https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=69356

URN (NBN):

urn:nbn:de:hbz:061-20250423-110953-5

Kollektion:

Dissertationen

Sprache:

Deutsch

Dokumententyp:

Wissenschaftliche Abschlussarbeiten » Dissertation

Medientyp:

Text

Autor:

Hepner, Fabienne [Autor]

Dateien:

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Dateien vom 14.04.2025 / geändert 14.04.2025

Beitragende:

Prof. Dr. med. Dr. med. dent. Rana, Majeed [Gutachter]
Univ. Prof. Dr. med. Beez, Thomas [Betreuer/Doktorvater]
Prof. Dr. med. Beseoglu, Kerim [Betreuer/Doktorvater]

Stichwörter:

Kranioplastik, Komplikationen, Nachblutungen, SHT, Dekompression, ICB

Dewey Dezimal-Klassifikation:

600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit

Beschreibungen:

Die dekompressive Hemikraniektomie (DHC) ist ein Notfalleingriff zur Behandlung eines erhöhten intrakraniellen Drucks, der durch verschiedene Erkrankungen wie traumatische Hirnverletzungen, Hirninfarkte oder intrakranielle Blutungen verursacht werden kann. Nach der Akutphase ist eine Rekonstruktion des Schädels erforderlich. Dieser Eingriff geht unter anderem aufgrund der großen Wundfläche mit einer relevanten Komplikationsrate einher. Zu den häufigsten Komplikationen zählen Nachblutungen und Infektionen. Ziel dieser Dissertation war die Analyse der frühen postoperativen Nachblutung und ihrer Risikofaktoren.
In diese retrospektive monozentrische Studie wurden Patienten eingeschlossen, die eine kraniale Rekonstruktion nach DHC mit autologer oder alloplastischer Kranioplastik als Primärrekonstruktion erhielten. Ausgeschlossen wurden Patienten unter 18 Jahren, mit bifrontaler oder suboccipitaler Dekompression und mit supratentoriellen Kraniektomien, die in Größe oder Lage nicht der standardmäßigen DHC entsprachen. Als frühe postoperative Nachblutung wurde ein Ereignis definiert, das innerhalb von 72 Stunden nach der Operation auftrat und durch eine kraniale Computertomographie (CCT) festgestellt wurde. Es wurden intrazerebrale, subdurale, epidurale sowie subgaleale Blutungslokalisationen erfasst.
Es wurden 538 Patienten (57 % männlich, 43 % weiblich) nach DHC eingeschlossen, die zwischen 2007 und 2021 überwiegend wegen eines Schädel-Hirn-Traumas (34 %) und eines ischämischen Insults (36 %) operiert wurden. Eine autologe Kranioplastik wurde bei 438 Patienten durchgeführt (81 %) und eine alloplastische Kranioplastik bei 100 Patienten (19 %). Die Gesamtkomplikationsrate der frühen Nachblutungen betrug 21 % (115 Patienten), von denen 43 Patienten (37 %) eine chirurgische Revision benötigten, wobei das epidurale Hämatom die häufigste Komplikation war (64 %), gefolgt vom subduralen Hämatom (23 %), unabhängig vom Material der Kranioplastik (autologer Knochen vs. alloplastisches Transplantat, OR 0.64, p = 0.155). Die Hälfte aller Komplikationen trat innerhalb von 12 Stunden nach dem Eingriff auf, 90 % innerhalb von 29 Stunden. Für weitere Prädiktoren konnte im logistischen Regressionsmodell ebenfalls kein signifikanter Zusammenhang für die Assoziation einer frühen Nachblutung nach Kranioplastik ermittelt werden (Chi-Quadrat= 10,84, df= 9, p= 0,287, Nagelkerke R2= 0,031).
Bei 21 % der Patienten nach Kranioplastik trat eine frühe postoperative Nachblutung auf. Diese führte in 37 % der Fälle zu einer Revisionsoperation. Das epidurale Hämatom stellt die häufigste Art der Nachblutung dar (64 %). Risikofaktoren konnten in diesem Kollektiv nicht identifiziert werden.

Decompressive hemicraniectomy (DHC) is an emergency procedure to treat increased intracranial pressure, which can be caused by various conditions such as traumatic brain injury, cerebral infarction, or intracranial bleeding. After the acute phase, reconstruction of the skull is required. This procedure is associated with a relevant complication rate due to the large wound area, among other things.
The most common complications include secondary bleeding and infection. The aim of this dissertation was to analyze early postoperative bleeding and its risk factors.
Patients who underwent cranial reconstruction after DHC with autologous or alloplastic cranioplasty as primary reconstruction were included in this retrospective monocentric study. Patients under 18 years of age, with bifrontal or suboccipital decompression and with supratentorial craniectomies that did not correspond in size or position to standard DHC were excluded. Early postoperative hemorrhage was defined as an event that occurred within 72 hours of surgery and was detected by cranial computed tomography (CCT). Intracerebral, subdural, epidural and subgaleal bleeding localizations were recorded.
The study included 538 patients (57 % male, 43 % female) after DHC who underwent surgery between 2007 and 2021, mainly for traumatic brain injury (34 %) and ischemic insult (36 %). Autologous cranioplasty was performed in 438 patients (81 %) and alloplastic cranioplasty in 100 patients (19 %). The overall complication rate of early postoperative bleeding was 21 % (115 patients), of which 43 patients (37 %) required surgical revision, with epidural hematoma being the most common complication (64%), followed by subdural hematoma (23%), regardless of cranioplasty material (autologous bone vs. alloplastic graft, OR 0.64, p=0.155). Half of all complications occurred within 12 hours after the procedure, 90 % within 29 hours. For other predictors, the logistic regression model was unable to determine a significant correlation for the association of early postoperative bleeding after cranioplasty (Chi-square= 10.84, df= 9, p= 0.287, Nagelkerke R2= 0.031).
Early postoperative bleeding occurs in 21 % of patients after cranioplasty. This leads to revision surgery in 37 % of cases. Epidural hematoma is the most common type of postoperative hemorrhage (64 %). No risk factors could be identified in this group.

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Dokument erstellt am:

23.04.2025

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23.04.2025

Promotionsantrag am:

15.07.2024

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08.04.2025

Heinrich-Heine-Universität Düsseldorf

Dokument: Frühe Nachblutungen nach Kranioplastiken - eine retrospektive Analyse