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A systematic review and meta-analysis of factors involved in bone flap resorption after decompressive craniectomy

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Abstract

Decompressive craniectomy (DC) is effective in controlling increasing intracranial pressure determined by a wide range of conditions, mainly traumatic brain injury (TBI) and stroke, and the subsequent cranioplasty (CP) displays potential therapeutic benefit in terms of overall neurological function. While autologous bone flap (ABF) harvested at the time of DC is the ideal material for skull defect reconstruction, it carries several risks. Aseptic bone flap resorption (BFR) is one of the most common complications, often leading to surgical failure. The aim of our study was to systematically review the literature and carry out a meta-analysis of possible factors involved in BFR in patients undergoing ABF cranioplasty after DC. A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Different medical databases (PubMed, Embase, and Scopus) were screened for eligible scientific reports until April 30th 2021. The following data were collected for meta-analysis to assess their role in BFR: sex, age, the interval time between DC and CP, the presence of systemic factors, the etiology determining the DC, CP surgical time, CP features, VP shunt placement, CP infection. Studies including pediatric patients or with less than 50 patients were excluded. Fifteen studies were included. There was a statistically significant increased incidence of BFR in patients with CPF > 2 compared to patients with CPF ≤ 2 (54.50% and 22.76% respectively, p = 0.010). TBI was a significantly more frequent etiology in the BFR group compared to patients without BFR (61.95% and 47.58% respectively, p < 0.001). Finally, patients with BFR were significantly younger than patients without BFR (39.12 ± 15.36 years and 47.31 ± 14.78 years, respectively, p < 0.001). The funnel plots were largely symmetrical for all the studied factors. Bone flap fragmentation, TBI etiology, and young age significantly increase the risk of bone resorption. Further studies are needed to strengthen our results and to clarify if, in those cases, a synthetic implant for primary CP should be recommended.

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Authors and Affiliations

  1. Depatment of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy

    Francesco Signorelli, Valerio Maria Caccavella, Alessandro Olivi & Nicola Montano

  2. Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy

    Martina Giordano, Valerio Maria Caccavella, Alessandro Olivi & Nicola Montano

  3. Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Eleonora Ioannoni, Camilla Gelormini & Anselmo Caricato

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  1. Francesco Signorelli
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  2. Martina Giordano
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  3. Valerio Maria Caccavella
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  4. Eleonora Ioannoni
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  5. Camilla Gelormini
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Contributions

All authors contributed to the study conception and design. Data collection was performed by Martina Giordano, Valerio Maria Caccavella, and Francesco Signorelli. Data analysis was performed by Francesco Signorelli, Nicola Montano, and Valerio Maria Caccavella. The first draft of the manuscript was written by Nicola Montano, Alessandro Olivi, and Anselmo Caricato. Camilla Gelormini, Eleonora Ioannoni, Alessandro Olivi, and Nicola Montano supervised the work. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Signorelli, F., Giordano, M., Caccavella, V.M. et al. A systematic review and meta-analysis of factors involved in bone flap resorption after decompressive craniectomy. Neurosurg Rev 45, 1915–1922 (2022). https://doi.org/10.1007/s10143-022-01737-z

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