Kranioplastie in Deutschland - Ergebnisse einer landesweiten Umfrage zur Kranioplastie

Cranioplasty (CP) post-decompressive craniectomy (DHC) commonly employs the patient's own bone flap (BF), stored intraabdominally or in a freezer. Recent legal concerns have brought the storage practices of explanted BFs into question. Moreover, new materials might offer superior outcomes, mitigating the risk of osteolysis. This study aimed to evaluate the prevailing CP methodologies in German medical centers.

From May to September 2023, a 24-item online survey was circulated via the German Society of Neurosurgery (DGNC), inquiring about the practices and frequencies of DHC and CP, along with the reasons for these practices.

Of the 76 respondents from German centers, the majority (41%) reported performing 25-50 DHCs annually. Only two centers conducted over 100 DHCs yearly, while nine centers performed fewer than 10. CP numbers post-DHC paralleled DHC figures: 41% conducted 25-50 CPs yearly, 38% 10-25, and a minority (five centers) exceeded 50. Regarding CP timing post-DHC, 57% waited 8-12 weeks, 11% opted for an earlier timeframe (<8 weeks), and 29% delayed CP beyond 12 weeks. Autologous bone, preferred by 47 centers, was favored for its biocompatibility (83%), cost-effectiveness (62%), and fit (32%). Deep-freezers were the primary BF storage method in 80% of centers, with only seven centers opting for intraabdominal storage. The discard policy for stored BFs varied, with 31% discarding within 12 months and 29% within 6 months. Ten centers kept BFs indefinitely. In centers using autologous bone, informed consent was sought for BF storage in only 49%. Alloplastic materials were the primary choice in 34% of centers, chosen for their fit (69%), biocompatibility (58%), and longevity (42%). Shifts away from autologous CP were driven mainly by organizational and legal challenges, along with concerns about osteolysis.

The survey unveils significant variability in CP approaches across Germany. Despite the gradual transition to alloplastic materials, autologous CP remains widely used. The practice of storing BFs in deep-freezers poses notable medicolegal risks, particularly without patient consent. The insights from our survey underscore the need for establishing community-wide guidelines.