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Complications of titanium cranioplasty—a retrospective analysis of 174 patients

  • Clinical Article - Brain Injury
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Abstract

Background

Titanium cranioplasty (TC) has been associated with high complication rates, but abundant data are lacking. We aimed to determine the incidence and type of complications following TC and risk factors for complications.

Methods

A retrospective review was performed on 174 patients who underwent TC at two London units over a seven year period. Data were collected on demographics, primary pathology, perioperative details, complications and functional outcome. Skull defect size was estimated using 3-dimensional computed tomographic reconstructions.

Results

The overall complication rate was 26.4 % (46/174), and plate removal rate10.3 % (18/174). The commonest complication was infection, which accounted for 69 % of plate removals. Patients who had undergone craniectomy for trauma had a higher complication rate (35 vs 21 %; p = 0.043) and plate removal rate (16 vs 7 %; p = 0.049) than others. There was a non-significant trend towards the association of craniectomy-to-cranioplasty interval of 4–8 months with the lowest complication rate and shortest postoperative hospital stay. Patients with a skull defect larger than 100 cm2 had the highest complication rate (p < 0.001), highest plate removal rate (p = 0.039), and longest postoperative hospital stay (p = 0.019). Bifrontal versus unilateral cranioplasty was associated with a significantly higher complication rate (40 vs 14 %) and length of hospital stay (5.0 vs 2.9 days). There was no perioperative mortality and no change between pre-operative and post-operative functional outcome.

Conclusion

In the largest UK study on cranioplasty to date, we have demonstrated that size of defect, traumatic aetiology and bifrontal insertion are risk factors for complications. Our results suggest that the timing of cranioplasty may be important with late (> 12 months) TC associated with a higher rate of complications, although further prospective studies on the optimal timing of TC are required to establish the observed trend. Our data can help clinicians stratify risk to inform the consent process and aid pre-operative planning.

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Acknowledgments

The authors would like to thank Mrs Jameela Jinnah from the Clinical Effectiveness & Audit office, St George’s Hospital, London, for kindly retrieving the medical notes of all patients who underwent titanium cranioplasty at St George’s Hospital.

Declaration of interest

The authors report no conflicts of interest.

Authors’ contributorship

The authors alone are responsible for the content and writing of the manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Atkinson Morley Wing, St George’s Hospital, London, SW17 0QT, UK

    Soumya Mukherjee, Bhaskar Thakur & Andrew J. Martin

  2. Department of Neurosurgery, King’s College Hospital, London, SE5 9RS, UK

    Imran Haq & Samantha Hettige

Authors
  1. Soumya Mukherjee
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  2. Bhaskar Thakur
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  3. Imran Haq
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  4. Samantha Hettige
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Corresponding author

Correspondence to Soumya Mukherjee.

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Comment

The authors provided a thorough review of a large series of 174 craniectomy patients treated exclusively with titanium cranioplasty (TC). Although the topic has been the subject of several prior reports and the study is retrospective in its character, the large cohort, the long follow-up interval and the careful data analysis of this series provide a wealth of interesting, relevant and useful information. Of particular interest is that size of skull defect, traumatic causes of craniectomy and bifrontal insertion of TC for cranioplasty seem to influence the risk of complications. Furthermore, although not statistically significant, both early (within 4 months) and late (after 12 months) TC tends to be associated with a higher complication rate. Despite the inherent but well discussed limitations of the study, the authors added a meaningful contribution to the growing literature on decompressive craniectomy and cranioplasty. Certainly, further and preferred prospective work needs to be done to address possible other factors affecting results of cranioplasty and patient outcome thereafter.

Marcus Oertel

Bern, Switzerland

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Mukherjee, S., Thakur, B., Haq, I. et al. Complications of titanium cranioplasty—a retrospective analysis of 174 patients. Acta Neurochir 156, 989–998 (2014). https://doi.org/10.1007/s00701-014-2024-x

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  • DOI: https://doi.org/10.1007/s00701-014-2024-x

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