Factors Predicting Poor Outcomes Following Cranioplasty: A Single Center Analytical Study

The study aims to assess the factors predicting poor outcomes after cranioplasty (CP).

A cross-sectional follow-up study including 80 patients who underwent CP following decompressive craniectomy (DC) and were followed up for six months. Poor outcome was defined as a modified Rankin Scale ≥3 at 6 months. Univariate and binary logistic regression analyses were used to explore the predictors.

Eighty patients were included; the median age was 53.5 years, and 48 were males (60%). The primary pathologies requiring DC were intracerebral hemorrhage (n= 28, 35%), traumatic brain injury (n= 27, 33.75%), and malignant middle cerebral infarction (n= 25, 31.25%). Pre-CP modified Rankin Scale was 5 in all patients, and a poor outcome was seen in 44 (55%) patients after CP. The significant predictors of poor outcome were age (odds ratio [OR= 1.96, P= 0.011), quadratic term age² (OR= 0.99, P= 0.011), primary pathology requiring DC as middle cerebral artery infarction (OR= 0.03, P= 0.024), dominant lobe injury (OR= 48.24, P= 0.001), presence of any post-DC complications (OR= 61.01, P = 0.025), use of CP material other than autologous skull flap (OR= 10.09, P= 0.035), and indication for CP other than for cosmesis (OR= 25.86, P= 0.014). Presenting Glasgow Coma Scale was not a predictor of poor outcome (P= 0.586) CONCLUSIONS: Both preoperative patient characteristics and procedural factors significantly influence post-CP recovery. Long-term functional outcomes are determined by patient factors like age, nature of injury (e.g., dominant lobe vs. nondominant lobe, which might affect rehabilitation potential), and surgical factors instead of initial neurological status.