gms | German Medical Science

Objective: Decompressive craniectomy (DC) is a lifesaving neurosurgical intervention against intractable intracranial pressure, however, necessitating a secondary surgery for cranioplasty. We aimed at identifying the risk factors related to autologous cranioplasty in a large institutional observational cohort.

Methods: This retrospective study included all patients undergoing autologous cranioplasty after DC at our institution between July 2007 and June 2017. Demographic and clinical parameters were collected from electronic medical database. All preoperative and postoperative computed tomography (CT) scans were additionally reviewed. The study endpoints were all documented complications related to cranioplasty.

Results: A total of 400 patients underwent autologous cranioplasty on the mean day 128.3 post-DC (range 9 – 601) and were therefore included to the final study. The mean age of the patients was 47.7 years (range 0 – 87years) and 45.3 % were females. Cranioplasty-related complication rates were 5%, 11% and 6.1% for bone flap resorption, rebleeding and bone graft infection respectively. The underlying primary brain pathology and the timeframe between DC and cranioplasty did not impact the risk of complications after cranioplasty. Younger patients were at significantly higher risk for bone flap resorption (p=0.009), whereat the clinically relevant cutoff was 40 years, according to the receiver operating curve. There was a trend toward higher risk of rebleeding in patients with "sunken brain" in pre-treatment CT scan (p=0.170). The patients with bone flap infections were insignificantly older (53.8 versus 47.8 years, p= 0.767). Shunt placement prior to cranioplasty did not increase the risk of complications (p=0.4697).

Conclusion: Autologous cranioplasty is a routine neurosurgical intervention, however, associated with certain surgical risks. Underlying brain pathology, cranioplasty timing and prior shunt placement did not seem to influence the risk of cranioplasty-related complications. Due to increased risk of bone flap resorption, younger individuals require a longer postoperative clinical follow-up.