Cranioplasty following decompressive craniectomy: minor surgical complexity but still high periprocedural complication rates
- 88 Downloads
Cranioplasty following decompressive craniectomy is of low surgical complexity, so much so that it has become the “beginners” cranial case. However, these “simple” procedures may have high complication rates. Identification of specific risk factors would allow targeted intervention to lower the complication rates. The aim of this study was to assess the rate of complications and to evaluate potential risk factors. We conducted a review of all patients who underwent cranioplasty in our center following decompressive craniectomy for stroke or brain trauma between 2009 and 2016. One hundred fifty-two patients were identified. Fifty-three percent were male. Mean age was 48 (range 11–78). Median time from craniectomy until cranioplasty was 102 days (range 14–378). The overall rate of complications, such as postoperative bleeding, seizures, postoperative infection, and hydrocephalus, was 30%. The mortality rate was 1%. None of the following potential risk factors was associated with significantly increased risk of periprocedural complications: gender (p = 0.34), age (p = 0.39), cause of initial surgery (p = 0.08), duration of surgery (p = 0.59), time of surgery (0.24), surgical experience (p = 0.17), and time from craniectomy until cranioplasty (p = 0.27). The 30-day complication rate following cranioplasty is high, but serious permanent deficits from these complications were rare. We found no clear predictor for these 30-day complications, which renders its prevention difficult.
KeywordsCranioplasty Complication rate Risk factor Mortality
The study was completely financed by the Department of Neurosurgery.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study, formal consent is not required.
- 5.Coulter IC, Pesic-Smith JD, Cato-Addison WB, Khan SA, Thompson D, Jenkins AJ, Strachan RD, Mukerji N (2014) Routine but risky: a multi-centre analysis of the outcomes of cranioplasty in the northeast of England. Acta Neurochir 156:1361–1368. https://doi.org/10.1007/s00701-014-2081-1 CrossRefPubMedGoogle Scholar
- 6.El Ahmadieh TY, Adel JG, El Tecle NE, Daou MR, Aoun SG, Nanney AD 3rd, Bendok BR (2013) Surgical treatment of elevated intracranial pressure: decompressive craniectomy and intracranial pressure monitoring. Neurosurg Clin N Am 24:375–391. https://doi.org/10.1016/j.nec.2013.03.003 CrossRefPubMedGoogle Scholar
- 8.Hofmeijer J, Amelink GJ, Algra A, van Gijn J, Macleod MR, Kappelle LJ, van der Worp HB, the Hi (2006) Hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial (HAMLET). Protocol for a randomised controlled trial of decompressive surgery in space-occupying hemispheric infarction. Trials 7:29–29. https://doi.org/10.1186/1745-6215-7-29 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Lillemae K, Jarvio J, Silvasti-Lundell MK, Antinheimo J, Hernesniemi J, Niemi TT (2017) Incidence of postoperative hematomas requiring surgical treatment in neurosurgery: a retrospective observational study. World Neurosurg 108:491–497. https://doi.org/10.1016/j.wneu.2017.09.007 CrossRefPubMedGoogle Scholar
- 14.Morton RP, Abecassis IJ, Hanson JF, Barber JK, Chen M, Kelly CM, Nerva JD, Emerson SN, Ene CI, Levitt MR, Chowdhary MM, Ko AL, Chesnut RM (2017) Timing of cranioplasty: a 10.75-year single-center analysis of 754 patients. J Neurosurg 1–5. https://doi.org/10.3171/2016.11.jns161917 CrossRefGoogle Scholar
- 18.Schirmer CM, Hoit DA, Malek AM (2007) Decompressive hemicraniectomy for the treatment of intractable intracranial hypertension after aneurysmal subarachnoid hemorrhage. Stroke 38:987–992. https://doi.org/10.1161/01.STR.0000257962.58269.e2 CrossRefPubMedGoogle Scholar
- 19.Shibahashi K, Hoda H, Takasu Y, Hanakawa K, Ide T, Hamabe Y (2017) Cranioplasty outcomes and analysis of the factors influencing surgical site infection: a retrospective review of more than 10 years of institutional experience. World Neurosurg 101:20–25. https://doi.org/10.1016/j.wneu.2017.01.106 CrossRefPubMedGoogle Scholar
- 20.Su TM, Lan CM, Lee TH, Shih FY, Hsu SW, Lu CH (2017) Posttraumatic cerebral infarction after decompressive craniectomy for traumatic brain injury: incidence, risk factors and outcome. Turk Neurosurg. https://doi.org/10.5137/1019-5149.jtn.20761-17.1