• James G Malcolm, Zayan Mahmooth, Rima S Rindler, Jason W Allen, Jonathan A Grossberg, Gustavo Pradilla, and Faiz U Ahmad.
• Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
• World Neurosurg. 2018 Aug 1; 116: 60-68.

ObjectiveConsensus regarding selection of synthetic versus autologous flap reimplantation for cranioplasty after decompressive craniectomy has not been reached and the multiple factors considered for each patient make comparative analysis challenging. This study examines the association between choice of material and related complications.MethodsA systematic literature review and meta-analysis were performed using PubMed for articles reporting delayed cranioplasty after decompressive craniectomy using a cohort design comparing autologous bone and synthetic implants. Extracted data included implant material and incidence of infection, reoperations related to implant, wound complications, and resorption.ResultsOne randomized controlled trial and 11 cohort studies were included for a total of 1586 implants (950 bone, 636 synthetic). Autologous implants had significantly more reoperations than did synthetic implants (n = 1586 implants; odds ratio [OR], 1.91; 95% confidence interval [CI], 1.40-2.61). Reoperations were most often because of resorption (54%, n = 159/295) followed by infection (41%, n = 121/295). The pooled incidence of resorption in autologous implants was 20% (n = 159/791). Among the other outcomes, there was no significant difference for infections (n = 1586; OR, 1.24; CI, 0.82-1.88) or wound complications (n = 678; OR, 0.56; CI, 0.22-1.45). For the trauma subpopulation, there was no significant difference in infection rate with either material (n = 197; OR, 1.89; CI; 0.59-6.09).ConclusionsAutologous implants had significantly more reoperations primarily because if the intrinsic risk of resorption (level of evidence 3b).Copyright © 2018 Elsevier Inc. All rights reserved.

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