• Br J Neurosurg · Oct 2013

    A retrospective analysis and review of an institution's experience with the complications of cranioplasty.

    • Lester Lee, Justin Ker, Boon Leong Quah, Ning Chou, David Choy, and Tseng Tsai Yeo.
    • Department of Neurosurgery, National University Hospital, Singapore. zhihaosg@hotmail.com
    • Br J Neurosurg. 2013 Oct 1; 27 (5): 629-35.

    IntroductionCranial reconstruction with a cranioplasty is performed to repair skull defects after decompressive craniectomies.AimsTo retrospectively review all cranioplasties performed in our institution over 10 years and analyse the complications and the factors that cause complications.Patient And MethodsTwo hundred and forty-three cranioplasties were performed from 2000 to 2010, with a follow-up of at least 1 year. Age, sex, comorbidities, material, site of skull defect, time between decompression and cranioplasty, and rate of complications were collected from our database. Fischer's T-test and direct logistical regression were performed to identify factors that contributed to the rate of complications. p < 0.05 was considered significant.ResultsPost-cranioplasty seizures (14.81%), infection and exposed implant (9.05%), haemorrhage (1.65%) and others (0.82%) were identified complications. Total percentage of complications was 25.92%. Previous trauma (p = 0.034) and intracranial haemorrhage (p = 0.019) as well as pre-cranioplasty neurological deficit (p = 0.046) were related to seizures, while pre-cranioplasty neurological deficit (p = 0.036) and exposed implant extrusion (p = 0.048) contributed to infection of cranioplasties.DiscussionMost of the seizures may be post-traumatic seizures or scar epilepsy from intracranial haemorrhage. Implant extrusions were found to be associated with infection of the implant, and they should therefore be treated early. Patient selection is important as patients with neurological deficits were susceptible to seizures and infection. Intracranial haemorrhage was caused by persistant bleeding, trauma or shunt overdrainge.ConclusionCranioplasty has significant complications. A thorough understanding of factors that contribute to the different types of complications will benefit the management of cranioplasty patients.

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