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Predictors of postoperative epidural hematomas after custom-made porous hydroxyapatite cranioplasty: a single-center experience of 194 consecutive cases

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Abstract

Cranioplasty is important for improving cosmesis and functional recovery after decompressive craniectomy. We assessed the incidence and predictors of post-cranioplasty epidural hematomas requiring surgical evacuation. A single-institution, retrospective study enrolled 194 consecutive patients who underwent a cranioplasty using custom-made hydroxyapatite between February 2008 and April 2022. Variables associated with postoperative epidural hematoma requiring surgical evacuation at the p < 0.1 level in unadjusted analysis were entered into multivariable analyses. Nine patients (4.6%) experienced postoperative epidural hematomas requiring evacuation, with time interval between craniectomy and cranioplasty <6 months (adjusted odds ratio (aOR), 20.75, p = 0.047), cranioplasty-to-bone shift > half of the bone thickness (aOR, 17.53, p = 0.008), >10 mm difference between pre-cranioplasty and post-cranioplasty midline brain shift contralateral to the cranioplasty (aOR, 17.26, p < 0.001), and non-resorbable duraplasty (aOR, 17.43, p = 0.011) identified as independent predictors. Seventeen patients (8.8%) experienced post-cranioplasty hydrocephalus requiring shunt placement. Twenty-six patients (13.4%) experienced postoperative infection. Sixteen patients (8.2%) had postoperative epileptic seizures. The identification of independent predictors of post-cranioplasty epidural hematomas requiring surgical evacuation will help identify at-risk patients, guide prophylactic care, and reduce morbidity of this common and important procedure.

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Authors and Affiliations

  1. Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France

    Aziz Bedioui, Angela Elia, Oumaima Aboubakr, Arthur Leclerc, Martin Planet, Giorgia Antonia Simboli, Alessandro Moiraghi, Houssem Fathallah, Eduardo Parraga, Chiara Benevello, Edouard Dezamis, Alexandre Roux, Marc Zanello & Johan Pallud

  2. Université Paris Cité, Paris, France

    Aziz Bedioui, Angela Elia, Oumaima Aboubakr, Arthur Leclerc, Martin Planet, Giorgia Antonia Simboli, Alessandro Moiraghi, Houssem Fathallah, Eduardo Parraga, Chiara Benevello, Edouard Dezamis, Alexandre Roux, Marc Zanello & Johan Pallud

  3. Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Angela Elia

  4. Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France

    Angela Elia, Giorgia Antonia Simboli, Alessandro Moiraghi, Alexandre Roux, Marc Zanello & Johan Pallud

  5. Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA

    Megan Still

  6. Department of Neurosurgery, Centre Hospitalier Universitaire Caen, Caen, France

    Arthur Leclerc

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  1. Aziz Bedioui
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Contributions

A.B., M.S., and J.P. wrote the main manuscript text. A.E. and J.P. made the statistical analyses. J.P. prepared Fig. 1. All authors reviewed the manuscript.

Corresponding author

Correspondence to Johan Pallud.

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An institutional review board approved the study protocol (IRB00011687, IRB#1:2022/41). The requirement to obtain informed consent was waived according to French legislation.

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The authors declare no competing interests.

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Marc Zanello and Johan Pallud participated equally.

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Bedioui, A., Elia, A., Still, M. et al. Predictors of postoperative epidural hematomas after custom-made porous hydroxyapatite cranioplasty: a single-center experience of 194 consecutive cases. Neurosurg Rev 46, 132 (2023). https://doi.org/10.1007/s10143-023-02039-8

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