Feasibility Study Of Super-early Titanium Mesh Cranioplasty

Objective: In order to recover the neurological function of patients with decompression of frontotemporal bone flap,timely and early repair of cranial cavity integrity is one of the important measures.The purpose of this study is to observe the advantages and disadvantages of Super-early and conventional cranioplasty in patients with 2-4W(super-early)cranioplasty after decompressive craniectomy,so as to determine the possibility of Super-early treatment.Methods:1.Sources and criteria: This study retrospectively analyzed the cases of cranioplasty in the Eastern Hospital of the Second Hospital of Hebei Medical University from October 2017 to April 2018.Selection criteria: 1)stable vital signs,good wound healing,no signs of infection in vivo;2)patients with bone flap decompression 2-4 weeks after operation were included in the ultra-early group;3)patients with bone flap decompression > 12 weeks after operation were included in the routine group.A total of 47 cases were eligible,of which 14 cases were in the ultra-early stage group(10 males,4 females and 1 case was lost to follow-up).In the routine group,33 cases(28 males,5 females,5 lost visits),a total of 6 lost visits.The missing rate was 12.76%.41 cases with complete data were included in this study.2.Surgical methods: 1)Routine surgical treatment;2)In ultra-early stage,the false membranes that did not form obvious false membranes were covered with thin layer of yarn at the speed of filament,and the damaged false membranes during operation were repaired with thread or/or covered with thin layer at the speed of filament.3.Observation items: To observe the adhesion between the skin and muscle flaps and the surface of brain tissue;to observe the operation time;and to observe the healing after operation.Postoperative complications(wound infection,intracranial infection,hydrocephalus,subcutaneous effusion,subdural effusion,epilepsy,etc.);Record the scores of living ability and neurological function before and 6 months after operation.4.Statistical analysis: The statistical software IBM SPSS Statistics 21.0 was used to analyze and process the data.The measurements were expressed by mean(+standard deviation)and the independent sample t test was used for comparison between groups.The counting data were expressed by percentage(%)and chi-square test was used for comparison between groups.The difference of test results was statistically significant with P<0.05.Results:1.Adhesion between skin and muscle flaps and the surface of brain tissue: There was no or slight adhesions in the super-early stage group,and the degree of adhesions was positively correlated with the time after operation,while in the conventional group,the adhesions between skin and muscle flaps and the surface of brain tissue were obvious.2.Operation time: Because of the different degree of adhesion between skin and muscle flaps and brain tissue,the operation time in the ultra-early group was 169.62±27.42)minutes,which was significantly shorter than that in the conventional group(203.21 ±46.81)minutes(t=-2.394,P=0.022).3.Complications: In the super-early cranioplasty group,there were 0 cases of scalp infection,0 cases of hydrocephalus,0 cases of subcutaneous hydrocephalus,1 case of subdural hydrocephalus and 1 case of epilepsy,with a total incidence of 2/13.In routine group,there were 0 cases of scalp infection,3 cases of hydrocephalus,3 cases of subcutaneous hydrocephalus,1 case of subdural hydrocephalus and 8 cases of epilepsy,with a total incidence of 15/28.Comparisons of postoperative complications were made between the two groups.There was no significant difference between the two groups(P> 0.05).4.There was no significant difference in GCS score between the two groups before repair(t=-0.837,P=0.408).Six months after operation,12 cases(92.3%)had good prognosis and 1 case(7.7%)had poor prognosis.The prognosis of routine group was good in 19 cases(67.8%)and bad in 9 cases(32.2%).Comparing the prognosis of the two groups,it was found that the prognosis of the ultra-early group was better than that of the conventional group.There was significant difference in the good prognosis rate between the ultra-early and conventional groups(x2=4.335,P=0.037).There was no significant difference in sex,age and area of skull defect between the two groups.Conclusion:This study suggests that super-early(2W-4W)titanium mesh cranioplasty is feasible after decompressive craniectomy,but its concl-usion needs to be verified by multi-center prospective controlled study.