Outcomes of cranial repair after craniectomy.

OBJECT: Hemicraniectomy is a commonly practiced neurosurgical intervention with a wide range of indications and clinical data supporting its use. The extensive use of this procedure directly results in more cranioplasties to repair skull defects. The complication rate for cranial repair after craniectomy seems to be higher than that of the typical elective craniotomy. This finding prompted the authors to review their experience with patients undergoing cranial repair.

METHODS: The authors performed a retrospective review of 212 patients who underwent cranial repair over a 13-year period at their institution. A database tracking age, presenting diagnosis, side of surgery, length of time before cranial repair, bone graft material used, presence of a ventricular shunt, presence of a postoperative drain, and complications was created and analyzed.

RESULTS: The overall complication rate was 16.4% (35 of 213 patients). Patients 0-39 years of age had the lowest complication rate of 8% (p = 0.028). For patients 40-59 years of age and older than 60, complication rates were 20 and 26%, respectively. Patients who originally presented with traumatic injuries had a lower rate of complications than those who did not (10 vs 20%; p = 0.049). Conversely, patients who presented with tumors had a higher complication rate than those without (38 vs 15%; p = 0.027). Patients who received autologous bone graft placement had a statistically significant lower risk of postoperative infection (4.6 vs 18.4%; p = 0.002). Patients who underwent cranioplasty with a 0-3 month interval between operations had a complication rate of 9%, 3-6 months 18.8%, and > 6 months 26%. Pairwise comparisons showed that the difference between the 0-3 month interval and the > 6-month interval was significant (p = 0.007). The difference between the 0-3 month interval and the 4-6 month interval showed a trend (p = 0.07). No difference was detected between the 4-6 month interval and > 6-month interval (p = 0.35).

CONCLUSIONS: The overall rate of complications related to cranioplasty after craniectomy is not negligible, and certain factors may be associated with increased risk. Therefore, when evaluating the need to perform a large decompressive craniectomy, the surgeon should also be aware that the patient is not only subject to the risks of the initial operation, but also the risks of subsequent cranioplasty.