• Mun-Chun Yeap, Po-Hsun Tu, Zhuo-Hao Liu, Po-Chuan Hsieh, Yu-Tse Liu, Ching-Yi Lee, Hung-Yi Lai, Chun-Ting Chen, Yin-Cheng Huang, Kuo-Chen Wei, Chieh-Tsai Wu, and Ching-Chang Chen.
• Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, Taoyuan City, Taiwan.
• World Neurosurg. 2019 Aug 1; 128: e841-e850.

ObjectiveCranioplasty is a technically simple procedure intended to repair defects of the skull to provide protection after craniectomy, improve functional outcomes, and restore cosmesis. Several materials have been used for the restoration of skull defects, including autologous bone grafts (AGs), polymethyl methacrylate (PMMA) flaps, and titanium mesh (T-mesh). However, the long-term results of cranioplasty after use of these materials are controversial.MethodsMedical records of 596 patients who underwent cranioplasty at our medical center between 2009 and 2015 with at least 2.5 years of follow-up were retrospectively reviewed. Patients were classified into 3 groups according to the materials used: AG, three-dimensional PMMA, and T-mesh. Demographic and clinical characteristics and postoperative complications were analyzed.ResultsCranioplasty with AG had the highest bone flap depression rate (4.9%; P = 0.02) and was associated with a 26% long-term bone flap resorption. Younger age was a risk factor for bone flap resorption. T-mesh had a higher risk of postoperative skin erosion and bone exposure (17%; P = 0.004). Patients with diabetes, previous craniotomy, or hydrocephalus showed a higher risk of postoperative skin erosion. PMMA was associated with the highest rate of postoperative infection (14.4% <3 months, 28.1% >3 months; P < 0.05), and previous craniotomy may increase the infection risk after cranioplasty with PMMA.ConclusionsComplications after cranioplasty are high, and the various types of cranioplasty materials used are associated with different complications. Surgeons need to be aware of these potential complications and should choose the appropriate material for each individual patient.Copyright © 2019 Elsevier Inc. All rights reserved.

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