Risk factors for complications following titanium mesh cranioplasty

Studies on complications following titanium mesh cranioplasty have predominantly focused on patients with cranial defects after decompressive craniectomy. This study investigates possible risk factors for complications using titanium mesh for smaller cranial defects.

All patients treated with titanium mesh cranioplasty over a 5-year period at Copenhagen University Hospital were identified. Demographics, comorbidities, and active smoking and drinking status were recorded in addition to indication for cranioplasty and operative findings. Severe complications recorded included superficial and deep infection, delayed wound defects, postoperative hematomas, and death within 30 days postoperatively. Minor complications recorded included skin atrophy, cosmetic complaints, pain, and loosening of the mesh. The management of complications was also documented.

A total of 247 patients with primary titanium mesh cranioplasty were included in the study. The overall complication rate was 17.4%. 15.0% suffered from severe complications and 2.4% developed minor complications. Elderly smokers, patients previously treated with radiation, and patients operated via a posterolateral approach to the skull base had the strongest association with complications. The complication rate was not higher in patients with cranioplasty after postoperative infections or in those with a frontobasal approach to the skull base compared with patient operated on for smaller cranial tumors.

The risk of complications following titanium mesh for smaller cranial defects is higher in elderly smokers, patients with a history of radiation, and those undergoing a posterolateral approach to the skull base.