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Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases
M Reid Gooch1, Greg E Gin, Tyler J Kenning
1Division of Neurosurgery, Albany Medical Center, Albany, New York 12208, USA.
Insights
Cranioplasty after decompressive craniectomy has a high complication rate. Bifrontal defects significantly increase the risk of complications and reoperation, highlighting the need for improved patient care strategies.
Area of Science:
- Neurosurgery
- Surgical Complications
- Patient Outcomes
Background:
- Decompressive craniectomy treats intracranial hypertension.
- Cranioplasty is necessary for cranial reconstruction post-craniectomy.
- Complications of cranioplasty are underreported.
Purpose of the Study:
- To review complications following cranioplasty.
- To identify risk factors for poor outcomes.
- To suggest measures for improved patient care.
Main Methods:
- Retrospective chart review of 62 patients undergoing cranioplasty.
- Recorded demographic, surgical, and complication data.
- Compared patient groups to identify predictors of reoperation.
Main Results:
- 34% immediate postoperative complication rate.
- 16 patients required reoperation.
- Bifrontal cranial defects significantly increased reoperation risk (p < 0.01).
Conclusions:
- Cranioplasty carries a high complication rate.
- Bifrontal defects are a significant risk factor for complications.
- Improved strategies are needed for post-craniectomy reconstruction.
Object:
Decompressive craniectomy is a potentially life-saving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or cerebral infarction. Once performed, surviving patients are obligated to undergo a second procedure for cranial reconstruction. The complications following cranial reconstruction are not well described in the literature and may very well be underreported. A review of the complications would suggest measures to improve the care of these patients.
Methods:
A retrospective chart review was undertaken of all patients who had undergone cranioplasty during a 7-year period. Demographic data, indications for craniectomy, as well as preoperative, intraoperative, and postoperative parameters following cranioplasty, were recorded. Perioperative and postoperative complications were also recorded. Patients were classified as having no complications, any complications, and complications requiring reoperation. The groups were compared to identify risk factors predictive of poor outcomes.
Results:
The authors identified 62 patients who had undergone cranioplasty. The immediate postoperative complication rate was 34%. Of these, 46 patients did not require reoperation and 16 did. Of those requiring reoperation, 7 were due to infection, 2 from wound breakdown, 2 from intracranial hemorrhage, 3 from bone resorption, and 1 from a sunken cranioplasty, and 1 patient's cranioplasty procedure was prematurely ended due to intraoperative hypotension and bradycardia. The only factor statistically associated with need for reoperation was the presence of a bifrontal cranial defect (bifrontal: 8 [67%] of 12, requiring reoperation; unilateral: 8 [16%] of 49 requiring reoperation; p < 0.01)
Conclusions:
Cranioplasty following decompressive craniectomy is associated with a high complication rate. Patients undergoing a bifrontal craniectomy are at significantly increased risk for postcranioplasty complications, including the need for reoperation.
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