Multidisciplinary Surgical Teams for Cranioplasty: Indications and Outcomes at a Single Institution

Cranioplasty is a common surgical procedure to repair skull defects. Due to cranioplasty's relatively high complication rates, multidisciplinary surgical teams (MSTs) of neurosurgeons and plastic surgeons have been suggested to improve patient outcomes. However, indications for MST remain undefined. To investigate when MSTs are used for cranioplasty and report patient population differences and outcomes compared with solo neurosurgeons (SN), a retrospective cohort study was performed at a single institution. Of 355 cranioplasties, 268 (75.5%) were performed by SN and 87 (24.5%) by a MST. Cranioplasty cases completed by MSTs had more prior surgeries ( P <0.001) and prior infectious etiology ( P <0.001). Surgery-related complications occurred in 32.2% of cases. Cranioplasty cases completed by MSTs had no difference in overall complication rates compared with SNs ( P =0.3360) but were more likely to experience an infectious complication (25.3% versus 10.1%, P <0.0001) and hydrocephalus (10.3% versus 3.0%, P =0.0091). Overall complication rates did not differ by cranioplasty implant type ( P =0.4837) or timing ( P =0.3921). The study was limited by selection bias. In conclusion, in this series MSTs were used in higher risk patients with more prior operations and infectious etiology, likely underlying the increased rate of infection and hydrocephalus. The results add to a growing literature supporting the use of MSTs for cranioplasty and raise the question of whether MST can provide better outcomes than SN in simple cranioplasty, which future prospective studies can address.