Complications of Cranioplasty Following Decompressive Craniectomy: Risk Factors of Complications and Comparison Between Autogenous and Artificial Bones

Objectives: Craniectomy is widely performed to lower the intracranial pressure in various conditions, such as traumatic brain injury, stroke, or brain swelling. Several complications can occur after craniectomy and cranioplasty, which significantly affect the prognosis of the patients after surgery. We studied the complications of craniectomy and cranioplasty and the factors affecting prognosis after the operation.

Methods: Patients who underwent cranioplasty after craniectomy at Daejeon St. Mary's Hospital from 2015 to 2021 were included. We retrospectively reviewed their medical records and images. All patients were classified according to their sex, age, clinical grade, and diagnosis. Complications after craniectomy and cranioplasty were investigated for 1 year after surgery. The complications included postoperative hemorrhage, infection, hydrocephalus, and bone resorption.

Results: This study included 104 patients. Complications after decompressive craniectomy were significantly frequent in patients with hypertension history (p=0.03). In contrast, complications of cranioplasty were significantly frequent in patients with history of diabetes mellitus, hepatic failure, or trauma (p=0.03, p<0.01, and p=0.01, respectively). Artificial bones were used more frequently than autologous bones in patients with trauma (p=0.03); however, there was no difference in the incidence of complications between them (p=0.64).

Conclusion: Hypertension is a significant risk factor for decompressive craniectomy complications, especially rebleeding. Diabetes, hepatic failure, and trauma are significant risk factors for cranioplasty complications. There was no statistical difference in the incidence of complications between the use of autologous and artificial bones.