• Ali Rashidi, Daniela Adolf, Dimitrios Karagiannis, Osamah Bani Melhem, and Michael Luchtmann.
• Department of Neurosurgery, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
• World Neurosurg. 2019 Jun 1; 126: e814-e818.

ObjectiveVarious complications that can occur during and after cranial surgery have been investigated extensively. One of the less frequent complications has thus far received little attention, however: displacement of the skull implant after craniotomy or craniectomy. The purpose of this study is to identify prognostic factors for the development of skull implant displacement (SID).MethodsIn this study, 9087 cranial surgeries performed between 2002 and 2017 were retrospectively examined for the occurrence of SID. Because a first analysis of the investigated data revealed that a notable number of SIDs occurred after a cranioplasty (CP) performed after a decompressive craniectomy (DC), we focused our investigation on these cases. A total of 669 DCs and 329 subsequently performed CPs were analyzed. Several factors were analyzed unadjusted as possible factors influencing the risk for the development of SID.ResultsA total of 13 implant dislocations occurred after CP (3.95%). Fixation technique is the only factor that seems to have had a significant influence, specifically not using miniplates as the fixation technique, which was associated with a higher risk of SID (P = 0.043). However, if fixation techniques are distinguished in more detail, no significant advantage of the miniplates over titanium clamps can be proven (P = 0.123). None of the remaining observed factors showed a statistically provable impact in our data.ConclusionsA notable number of SIDs only occur after CPs that follow a DC. An advantage in successful placement was observed when fixation of the skull implant during cranioplasty was performed using miniplates.Copyright © 2019 Elsevier Inc. All rights reserved.

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