Predictive Factors for Cranioplasty Complications - A Decade's Experience

Overview

Journal Brain Spine

Specialty Neurology

Date 2024 Sep 24

PMID 39315400

Authors

Ana Ferreira

Victor Viegas

Antonio Cerejo

Pedro Alberto Silva

Affiliations

Soon will be listed here.

Abstract

Introduction: Cranioplasty (CP) following craniectomy provides cerebral protection, improves cerebrospinal fluid dynamics, and restores cosmesis. Although often viewed as minor, CP can have major complications.

Research Question: This study aims to identify the predictive factors for post-operative complications in patients undergoing CP after decompressive craniectomy.

Methods: We conducted a retrospective study at a tertiary hospital, analyzing patients who underwent CP after decompressive craniectomy (DC) from 2008 to 2019. Patient demographics, medical history, and surgery details were retrieved from hospital records. Complications included symptomatic intracerebral haemorrhage, extradural or subdural haemorrhage, hydrocephalus, infection, or bone resorption.

Results: The study included 168 patients: 139 adults (mean age 47.6 ± 12.68 years) and 29 pediatric patients (mean age 11.8 ± 5.62 years), with a slight male predominance. The overall complication rate was 26.2%, with infection being the most common (8.9%). Predictive factors for CP complications identified by binomial logistic regression, controlling for age and sex, included primary coagulopathy (14.3-fold risk increase, p = 0.034), intraoperative ventricular puncture (7.9-fold risk increase, p = 0.009), and intraoperative dural layer breach (2.8-fold risk increase, p = 0.033). Pre-CP home living was a protective factor.

Conclusions: CP requires vigilant management to prevent complications. Primary coagulopathy, intraoperative ventricular puncture, and dural layer breach are significant risk factors for complications.

References

Sobani Z, Shamim M, Zafar S, Qadeer M, Bilal N, Murtaza S . Cranioplasty after decompressive craniectomy: An institutional audit and analysis of factors related to complications. Surg Neurol Int. 2011; 2:123. PMC: 3205490. DOI: 10.4103/2152-7806.85055. View

Jeong S, Wang U, Kim S, Ha S, Kim J . Symptomatic Epidural Fluid Collection Following Cranioplasty after Decompressive Craniectomy for Traumatic Brain Injury. Korean J Neurotrauma. 2016; 12(1):6-10. PMC: 4866558. DOI: 10.13004/kjnt.2016.12.1.6. View

Goedemans T, Verbaan D, van der Veer O, Bot M, Post R, Hoogmoed J . Complications in cranioplasty after decompressive craniectomy: timing of the intervention. J Neurol. 2020; 267(5):1312-1320. PMC: 7184041. DOI: 10.1007/s00415-020-09695-6. View

Heo J, Park S, Cho S, Chang J, Park H . Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures. J Neurosurg. 2014; 121(2):313-8. DOI: 10.3171/2014.2.JNS131480. View

Singh S, Singh R, Jain K, Walia B . Cranioplasty following decompressive craniectomy - Analysis of complication rates and neurological outcomes: A single center study. Surg Neurol Int. 2019; 10:142. PMC: 6744790. DOI: 10.25259/SNI_29_2019. View

Rocque B, Agee B, Thompson E, Piedra M, Baird L, Selden N . Complications following pediatric cranioplasty after decompressive craniectomy: a multicenter retrospective study. J Neurosurg Pediatr. 2018; 22(3):225-232. DOI: 10.3171/2018.3.PEDS17234. View

Schirmer C, Ackil Jr A, Malek A . Decompressive Craniectomy. Neurocrit Care. 2008; 8(3):456-70. DOI: 10.1007/s12028-008-9082-y. View

Vreeburg R, Singh R, van Erp I, Korhonen T, Yue J, Mee H . Early versus delayed cranioplasty after decompressive craniectomy in traumatic brain injury: a multicenter observational study within CENTER-TBI and Net-QuRe. J Neurosurg. 2024; 141(4):895-907. DOI: 10.3171/2024.1.JNS232172. View

Hng D, Bhaskar I, Khan M, Budgeon C, Damodaran O, Knuckey N . Delayed Cranioplasty: Outcomes Using Frozen Autologous Bone Flaps. Craniomaxillofac Trauma Reconstr. 2015; 8(3):190-7. PMC: 4532567. DOI: 10.1055/s-0034-1395383. View

10.

Jung H, Jang K, Choi H, Nam T, Park Y, Kwon J . Comparison of Postoperative Surgical-Site Infection and Symptomatic Intracranial Hemorrhage between Staged and Simultaneous Cranioplasty with Ventriculoperitoneal Shunt Placement: A Meta-Analysis. Korean J Neurotrauma. 2020; 16(2):235-245. PMC: 7607022. DOI: 10.13004/kjnt.2020.16.e16. View

11.

Akamatsu Y, Hayashi T, Yamamoto J, Karibe H, Kameyama M, Tominaga T . Newly Diagnosed Acquired Hemophilia A Manifesting as Massive Intracranial Hemorrhage Following a Neurosurgical Procedure. World Neurosurg. 2017; 111:175-180. DOI: 10.1016/j.wneu.2017.12.016. View

12.

Oh C, Park C, Hyun D, Park H, Yoon S . Comparative Study of Outcomes between Shunting after Cranioplasty and in Cranioplasty after Shunting in Large Concave Flaccid Cranial Defect with Hydrocephalus. J Korean Neurosurg Soc. 2008; 44(4):211-6. PMC: 2588309. DOI: 10.3340/jkns.2008.44.4.211. View

13.

Ting C, Lu C, Lan C, Lee T, Hsu S, Su T . Simultaneous cranioplasty and ventriculoperitoneal shunt placement in patients with traumatic brain injury undergoing unilateral decompressive craniectomy. J Clin Neurosci. 2020; 79:45-50. DOI: 10.1016/j.jocn.2020.07.015. View

14.

Malcolm J, Rindler R, Chu J, Chokshi F, Grossberg J, Pradilla G . Early Cranioplasty is Associated with Greater Neurological Improvement: A Systematic Review and Meta-Analysis. Neurosurgery. 2017; 82(3):278-288. DOI: 10.1093/neuros/nyx182. View

15.

Smith M . Refractory Intracranial Hypertension: The Role of Decompressive Craniectomy. Anesth Analg. 2017; 125(6):1999-2008. DOI: 10.1213/ANE.0000000000002399. View

16.

Gooch M, Gin G, Kenning T, German J . Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus. 2009; 26(6):E9. DOI: 10.3171/2009.3.FOCUS0962. View

17.

Yang X, Wang H, Wen L, Huang X, Li G, Gong J . The safety of simultaneous cranioplasty and shunt implantation. Brain Inj. 2017; 31(12):1651-1655. DOI: 10.1080/02699052.2017.1332781. View

18.

Sahoo N, Tomar K, Thakral A, Rangan N . Complications of Cranioplasty. J Craniofac Surg. 2018; 29(5):1344-1348. DOI: 10.1097/SCS.0000000000004478. View

19.

Mustroph C, Malcolm J, Rindler R, Chu J, Grossberg J, Pradilla G . Cranioplasty Infection and Resorption Are Associated with the Presence of a Ventriculoperitoneal Shunt: A Systematic Review and Meta-Analysis. World Neurosurg. 2017; 103:686-693. DOI: 10.1016/j.wneu.2017.04.066. View

20.

Riyaz M, Waqas M, Ujjan B, Akhunzada N, Hadi Y, Javed G . Decompressive craniectomy for infants: a case series of five patients. Childs Nerv Syst. 2015; 31(11):2117-22. DOI: 10.1007/s00381-015-2808-1. View