Cranioplasty following decompressive craniectomy: minor surgical complexity but still high periprocedural complication rates

  • Ehab Shiban
  • Nicole LangeEmail author
  • Antonia Hauser
  • Ann-Kathrin Jörger
  • Arthur Wagner
  • Bernhard Meyer
  • Jens Lehmberg
Original Article


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.


Cranioplasty Complication rate Risk factor Mortality 


Funding information

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.

Ethical approval

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.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Archavlis E, Carvi Y Nievas M (2012) The impact of timing of cranioplasty in patients with large cranial defects after decompressive hemicraniectomy. Acta Neurochir 154:1055–1062. CrossRefPubMedGoogle Scholar
  2. 2.
    Archavlis E, Carvi YNM (2012) The impact of timing of cranioplasty in patients with large cranial defects after decompressive hemicraniectomy. Acta Neurochir 154:1055–1062. CrossRefPubMedGoogle Scholar
  3. 3.
    Beauchamp KM, Kashuk J, Moore EE, Bolles G, Rabb C, Seinfeld J, Szentirmai O, Sauaia A (2010) Cranioplasty after postinjury decompressive craniectomy: is timing of the essence? J Trauma 69:270–274. CrossRefPubMedGoogle Scholar
  4. 4.
    Chang V, Hartzfeld P, Langlois M, Mahmood A, Seyfried D (2010) Outcomes of cranial repair after craniectomy. J Neurosurg 112:1120–1124. CrossRefPubMedGoogle Scholar
  5. 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. CrossRefPubMedGoogle Scholar
  6. 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. CrossRefPubMedGoogle Scholar
  7. 7.
    Gooch MR, Gin GE, Kenning TJ, German JW (2009) Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 26:E9. CrossRefPubMedGoogle Scholar
  8. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Joswig H, Gautschi OP, El Rahal A, Sveikata L, Bartoli A, Hildebrandt G, Schaller K, Stienen MN (2016) Cranioplasty: is surgical education safe? World Neurosurg 91:81–88. CrossRefPubMedGoogle Scholar
  10. 10.
    Krause-Titz UR, Warneke N, Freitag-Wolf S, Barth H, Mehdorn HM (2016) Factors influencing the outcome (GOS) in reconstructive cranioplasty. Neurosurg Rev 39:133–139. CrossRefPubMedGoogle Scholar
  11. 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. CrossRefPubMedGoogle Scholar
  12. 12.
    Malcolm JG, Rindler RS, Chu JK, Chokshi F, Grossberg JA, Pradilla G, Ahmad FU (2017) Early cranioplasty is associated with greater neurological improvement: a systematic review and meta-analysis. Neurosurgery 82:278–288. CrossRefGoogle Scholar
  13. 13.
    Malcolm JG, Rindler RS, Chu JK, Grossberg JA, Pradilla G, Ahmad FU (2016) Complications following cranioplasty and relationship to timing: a systematic review and meta-analysis. J Clin Neurosci 33:39–51. CrossRefGoogle Scholar
  14. 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. CrossRefGoogle Scholar
  15. 15.
    Piazza M, Grady MS (2017) Cranioplasty. Neurosurg Clin N Am 28:257–265. CrossRefPubMedGoogle Scholar
  16. 16.
    Piedra MP, Nemecek AN, Ragel BT (2014) Timing of cranioplasty after decompressive craniectomy for trauma. Surg Neurol Int 5:25. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Reddy S, Khalifian S, Flores JM, Bellamy J, Manson PN, Rodriguez ED, Dorafshar AH (2014) Clinical outcomes in cranioplasty: risk factors and choice of reconstructive material. Plast Reconstr Surg 133:864–873. CrossRefPubMedGoogle Scholar
  18. 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. CrossRefPubMedGoogle Scholar
  19. 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. CrossRefPubMedGoogle Scholar
  20. 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.
  21. 21.
    Tsang AC, Hui VK, Lui WM, Leung GK (2015) Complications of post-craniectomy cranioplasty: risk factor analysis and implications for treatment planning. J Clin Neurosci 22:834–837. CrossRefPubMedGoogle Scholar
  22. 22.
    Walcott BP, Kwon CS, Sheth SA, Fehnel CR, Koffie RM, Asaad WF, Nahed BV, Coumans JV (2013) Predictors of cranioplasty complications in stroke and trauma patients. J Neurosurg 118:757–762. CrossRefPubMedGoogle Scholar
  23. 23.
    Wang H, Zhang K, Cao H, Zhang X, Li Y, Wei Q, Zhang D, Jia Q, Bie L (2017) Seizure after cranioplasty: incidence and risk factors. J Craniofac Surg 28:e560–e564. CrossRefPubMedGoogle Scholar
  24. 24.
    Winkler PA, Stummer W, Linke R, Krishnan KG, Tatsch K (2000) The influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism. Neurosurg Focus 8:e9CrossRefGoogle Scholar
  25. 25.
    World-Medical-Association (2013) Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310:2191–2194. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Klinikum rechts der IsarTechnical University MunichMunichGermany

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