gms | German Medical Science

Objective: Cranioplasty (CP) is considered a standard procedure in neurosurgical practice for patients after (decompressive) craniectomy. Nevertheless, cranioplastic surgery is not standardized, carried out in different ways and is associated with high complication rates. Here we report our experiences with the use of different cranioplastic materials and discuss problems of CP surgery, complications and long-term follow up of these patients.

Methods: We retrospectively analysed the medical records of all patients with CP between 2004 and 2015 at our institution. We analysed demographic data, initial clinical diagnosis and surgery-associated complications. This was followed by a prospective analysis in which all patients were contacted. A neurological status (mRS) was evaluated and the cosmetic result was assessed using a special questionnaire.

Results: A total of 392 patients (182 females, 210 males) with a mean age of 48 years were included. These patients underwent a total of 508 cranioplastic surgeries. The most common indications for craniectomy were space-occupying cerebral infarction (30.1%), TBI (26.5%) and aSAH (17.8%). CP was performed at four different time periods: 1. ultra early CP (<30d) in 3%; 2. early CP (30-90d) in 31%; 3. late CP (90-180) in 44%, 4. very late CP (>180d) in 23%. The most commonly used CP material was autologous bone (57%) followed by PMMA (31%), PEEK (8%) and Titanium (4%). The overall complication rate of primary CP was 35.7%, due to bone resorption (10.7%) and graft infection (7.9%). In the case of revision CP, the complication rate was 32.2%, but mainly due to an increased postoperative haemorrhage (8.7%) and increased wound healing disorder (9.5%). A total of 112 patients participated in the prospective long-term analysis. Approximately half of the patients were unavailable and 72 patients were dead at the time of the survey. Of the participating patients 69% showed at least a favourable neurological outcome (mRS≥3). Concerning the cosmetic result, 56.7% of the patients were satisfied, 36.5% complained of paraesthesia at the implant and at least 24% had functional limitations (e.g. problems with chewing or eyelid closure).

Conclusion: The results of this single-center analysis demonstrate that CP surgery is associated with high complication rates. However, favourable neurological outcomes and satisfying cosmetic results can be achieved in a considerable proportion of patients. Further studies are necessary to optimize modalities of CP surgery.