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Complications of cranioplasty following decompressive craniectomy for traumatic brain injury: systematic review and meta-analysis

  • Review Article - Brain trauma
  • Published:
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Abstract

Background

Decompressive craniectomy (DC) is a common neurosurgical intervention for severe traumatic brain injury (TBI), as well as malignant stroke, malignancy and infection. DC necessitates subsequent cranioplasty. There are significant demographic differences between TBI and non-TBI patients undergoing cranioplasty, which may influence their relative risk profiles for infection, aseptic bone flap resorption (aBFR) and re-operation.

Objective

Perform a meta-analysis to determine the relative infection, aBFR and re-operation risk profiles of TBI patients as compared to other indications for DC.

Methods

A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. PubMed, MEDLINE, EMBASE and Google Scholar were searched until 26/11/2020. Studies detailing rates of infection, re-operation and/or aBFR in specific materials and the post-TBI population were included, while studies in paediatrics or craniosynostosis repair were excluded.

Results

Twenty-six studies were included. There was no difference in relative risk of infection between TBI and non-TBI cohorts (RR 0.81, 95% CI 0.57–1.17), with insignificant heterogeneity (I2 = 33%). TBI was a risk factor for aBFR (RR 1.54, 95% CI 1.25–1.89), with no significant heterogeneity (I2 = 13%). TBI was a risk factor for re-operation in the autologous sub-group (RR 1.49, 95% CI 1.05–2.11) but not in the alloplastic sub-group (RR = 0.86, 95% CI 0.34–2.18). Heterogeneity was insignificant (I2 = 11%).

Conclusion

TBI is a risk factor for aBFR and re-operation following cranioplasty. Use of an alloplastic graft for primary cranioplasty in these patients may partially mitigate this increased risk.

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  1. National Centre for Neurosurgery, Beaumont Hospital, Dublin, Ireland

    Jack Henry, Michael Amoo, Adam Murphy & David P. O’Brien

  2. School of Medicine, University College Dublin, Dublin, Ireland

    Jack Henry

  3. Royal College of Surgeons Ireland, Dublin, Ireland

    Michael Amoo & David P. O’Brien

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Concept and design: JH, MA, and DP O’B

Screening and data collation: JH and AM

Statistical analysis: JH

Interpretation of data: JH, MA, AM, and DP O’B

Writing: JH, MA, AM, and DP O’B

Review and revision of manuscript: JH, MA, AM, and DP O’B

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Henry, J., Amoo, M., Murphy, A. et al. Complications of cranioplasty following decompressive craniectomy for traumatic brain injury: systematic review and meta-analysis. Acta Neurochir 163, 1423–1435 (2021). https://doi.org/10.1007/s00701-021-04809-z

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