Predictive factors for cranioplasty complications - A decade's experience

Introduction: Cranioplasty (CP) following craniectomy provides cerebral protection, improves cerebrospinal fluid dynamics, and restores cosmesis. Although often viewed as minor, CP can have major complications.

Research question: This study aims to identify the predictive factors for post-operative complications in patients undergoing CP after decompressive craniectomy.

Methods: We conducted a retrospective study at a tertiary hospital, analyzing patients who underwent CP after decompressive craniectomy (DC) from 2008 to 2019. Patient demographics, medical history, and surgery details were retrieved from hospital records. Complications included symptomatic intracerebral haemorrhage, extradural or subdural haemorrhage, hydrocephalus, infection, or bone resorption.

Results: The study included 168 patients: 139 adults (mean age 47.6 ± 12.68 years) and 29 pediatric patients (mean age 11.8 ± 5.62 years), with a slight male predominance. The overall complication rate was 26.2%, with infection being the most common (8.9%). Predictive factors for CP complications identified by binomial logistic regression, controlling for age and sex, included primary coagulopathy (14.3-fold risk increase, p = 0.034), intraoperative ventricular puncture (7.9-fold risk increase, p = 0.009), and intraoperative dural layer breach (2.8-fold risk increase, p = 0.033). Pre-CP home living was a protective factor.

Conclusions: CP requires vigilant management to prevent complications. Primary coagulopathy, intraoperative ventricular puncture, and dural layer breach are significant risk factors for complications.