The Clinical Analysis Of Skull Defect Repaired By Refrigerated Autologous Skull

Objective: To analyze the postoperative complications of skull defect repair surgery by avariety of materials, incuding polymer material, antologous skull stored in the subskin of rightthigh, antologous skull stored in low temperature refrigerator and titanium plate. And toinvestigate the clinical evidence for the timing and complication of skull defect repaired byautologous skull.Method:229 cases of cranioplasty caused by skull defect from April 1999 to April 2011 inChaozhou Central Hospital were retrospectively analyzed, 17 cases were repaired by polymermaterial, 58 cases were repaired by titanium plate and 154 cases were repaired by autologousskul, while 57 cases were repared by antologous skull stored in the subskin of right thigh, 97cases were repared by antologous skull stored in ultra-low temperature refrigerator. The resultsamong different repair material, different age group and different spacing interval werecompared. The incidence of various complications after the cranioplasty was compared by themeans of chi-square test and nonparametric statistics, while SPSS 16.0 was used as the analysissoftware.Result:1. When the cranioplasty was accomplished by polymer material, the infection rate was17.65% (3/17), the dysphoria rate was 17.65% (3/17), the epilepsy rate was 17.65% (3/17), andthe subcutaneous effusion rate was 23.53% (4/17). When the cranioplasty was accomplished bytitanium plate, the infection rate was 0.00%, the dysphoria rate was 1.72% (1/58), the epilepsyrate was 8.62% (5/58), and the subcutaneous effusion rate was 3.45% (2/58). When thecranioplasty was accomplished by autologous skull, the infection rate was 1.30%, the dysphoriarate was 9.74% (15/154), the epilepsy rate was 3.25% (5/154), and the subcutaneous effusionrate was 5.84% (9/154). The complications incidence of the polymer material group wasobviously higher than those of autologous skull group and titanium plate group (P<0.05). Therewas no significant difference statistically between autologous skull group and titanium plategroup (P>0.05). 2. The dysphoria rate of the 20-30 years old group was 12.70% (8/63), and the 30-40 yearsold group was 13.46% (7/52), which was obviously higher than those of the other groups. Therewas no significant difference statistically between this two groups (P>0.05).3. The dysphoria rate was 16.05% (13/81) when the cranioplasty was accomplished in90-180 days after the craniotomy, which was the highest among all the groups. There wassignificant difference statistically between 90-180 days group and the other groups (P>0.05).4. The subcutaneous effusion increased with the age increasing, the 0-20 years old groupwas 0.00%, the 20-30 years old group was 3.18% (2/63), the 30-40 years old group was 9.62%(5/52), the 40-50 years old group was 10.64% (5/47), and the highest was 50 years old group(11.54%) (3/26). There was significant difference statistically between these groups (P<0.05).5. There was no significance statistically for the complications incidence when theautologous skulls were conserved by different methods (stored in the subskin of right thigh andultra-low temperature refrigerator.). The postoperative infection rate was 0.00%, the dysphoriarate was 5.26% (3/57), the epilepsy rate was 1.75% (1/57), and the subcutaneous effusion ratewas 5.26% (3/57) when the autologous skull was stored in subcutaneous of right thigh. Thepostoperative infection rate was 2.06% (2/97), the dysphoria rate was 12.37% (12/97), theepilepsy rate was 4.12% (4/97), and the subcutaneous effusion rate was 6.19% (6/97) when theautologous skull was cryopreserved. There was no significant difference statistically betweenthe two groups (P>0.05).ConclusionsConclusions:1. The complications incidence was obviously lower when the cranioplasty wasaccomplished by autologous skull and titanium plate, while the complications incidence washigher when the surgery was accomplished by polymer materials. But titanium plate had lots ofdisadvantages such as expensive, easily transformed, hard to change shape and made thepatients feel uncomfortable. Therefore, autologous skull was the ideal material for cranioplasty.2. Surgical repair of skull defects in early stage (less than 3 months after craniectomy) wasevidence-based.3. There was no significance statistically for the complications incidence when theautologous skull was conserved by different methods, but the skull was easily to change shapeand the patients felt uncomfortable when the autologous skull was stored in subcutaneous of right thigh, therefore, hypothermic preservation was the ideal method to keep the autologousskull.