Prognosis-Guided Reconstruction of Scalp and Skull Defects in Neurosurgical Patients

This study aimed to formulate reconstructive recommendations for neurosurgical patients presenting with scalp and/or skull defects based on outcomes in a large series of patients.

An institutional review board-approved retrospective review of patients who underwent scalp and/or calvarial reconstruction was conducted. Complications were divided into minor and major; early, intermediate, and late. Univariate logistic regression models were conducted to identify independent predictors of complications. Mann-Whitney U tests were used to compare survival time. Kaplan-Meier curves were developed to compare exposure of titanium and bone cranioplasties.

One hundred seventy-one patients who underwent 418 procedures were included (median 1 [1-3] surgeries per patient). Average age was 55 ± 15 years; 53% of patients were male. Median follow-up was 25.5 months [13.9-55.6 months], and 57 patients (33%) were deceased. Complications occurred following 48% of procedures; most common were titanium hardware exposure (36%), nonhealing wounds (23%), and infection (9%). Titanium cranioplasties became exposed 0.47 months [0.3-4.0 months] postoperatively. Frontal defect location was an independent predictor of major complications (odds ratio, 1.59; 95% confidence interval, 1.06-2.39; P = 0.026). Mortality rate for malignant intracranial neoplasms was 68.4% (median survival, 4.3 months), 39.1% for malignancies of both scalp and skull (7.0 months), 37.5% for scalp cancers (16.0 months), and 16.7% for meningiomas (28.2 months).

Neurosurgical patients requiring scalp and/or skull reconstruction are a complex population undergoing multiple procedures with high complication rates. Given high exposure rate of titanium hardware shortly after reconstruction, titanium cranioplasty is recommended for patients with a prognosis less than 2 to 8 months.