Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(03): 423-428
DOI: 10.1055/s-0042-1751007
Original Article

Outcomes and Associated Complications of Cranioplasty following Craniectomy in Brunei Darussalam

Caroline S.M. Shie
1   Department of Neurosurgery, Brunei Neuroscience, Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Jerudong, Brunei Darussalam
,
Dawn Antony
1   Department of Neurosurgery, Brunei Neuroscience, Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Jerudong, Brunei Darussalam
,
Ady Thien
1   Department of Neurosurgery, Brunei Neuroscience, Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Jerudong, Brunei Darussalam
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Objective Cranioplasty, commonly performed after decompressive craniectomy, is associated with significant complications. We aim to characterize the outcomes and complications post cranioplasty performed in Brunei Darussalam.

Methods and Materials We conducted a nationwide retrospective study of the patients who underwent cranioplasty. Patients who underwent cranioplasty by the Neurosurgical Department from January 2014 to June 2019 were included. Patients were excluded if they did not have a minimum of 30-days follow-up or the initial cranioplasty was performed elsewhere. Outcomes including complications post cranioplasty and 30-day and 1-year failure rates were assessed. All statistical analyses were performed with SPSS version 20 (IBM Corporation, Armonk, New York, USA). The χ2 test, Student's t-test, and the Mann–Whitney U test were performed for nominal, normally, and non-normally distributed variables, respectively. Multivariate logistic regression was used to assess predictors for complications and cranioplasty failure.

Results Seventy-seven patients with a median age of 48 (interquartile range, 37–61) years were included. Most cranioplasties used autologous bone (70/77, 90.9%). Infection and overall complication rates were 3.9% and 15.6%, respectively. Cranioplasty failure (defined as removal or revision of cranioplasty) rate was 9.1%. Previous cranial site infection post craniectomy was associated with cranioplasty failure (odds ratio: 12.2, 95% confidence interval [1.3, 114.0], p=0.028).

Conclusions Cranioplasty is generally associated with significant complications, including reoperation for implant failure. We highlighted that autologous bone cranioplasties can be performed with an acceptable low rate of infection, making it a viable first option for implant material.

Keywords

cranioplasty - complication - failure - autologous bone

Note

This paper was presented at Brunei Neuroscience, Stroke and Rehabilitation Centre Frontiers, Brunei Darussalam, on November 3 2019.




Publication History

Article published online:
01 September 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Alkhaibary A, Alharbi A, Alnefaie N, Oqalaa Almubarak A, Aloraidi A, Khairy S. Cranioplasty: a comprehensive review of the history, materials, surgical aspects, and complications. World Neurosurg 2020; 139: 445-452
    CrossrefPubMedGoogle Scholar
  • 2 Thien A, King NKK, Ang BT, Wang E, Ng I. Comparison of polyetheretherketone and titanium cranioplasty after decompressive craniectomy. World Neurosurg 2015; 83 (02) 176-180
    CrossrefPubMedGoogle Scholar
  • 3 Zanaty M, Chalouhi N, Starke RM. et al. Complications following cranioplasty: incidence and predictors in 348 cases. J Neurosurg 2015; 123 (01) 182-188
    CrossrefPubMedGoogle Scholar
  • 4 Wachter D, Reineke K, Behm T, Rohde V. Cranioplasty after decompressive hemicraniectomy: underestimated surgery-associated complications?. Clin Neurol Neurosurg 2013; 115 (08) 1293-1297
    CrossrefPubMedGoogle Scholar
  • 5 Liang ES, Tipper G, Hunt L, Gan PYC. Cranioplasty outcomes and associated complications: a single-centre observational study. Br J Neurosurg 2016; 30 (01) 122-127
    CrossrefPubMedGoogle Scholar
  • 6 Honeybul S, Ho KM. Cranioplasty: morbidity and failure. Br J Neurosurg 2016; 30 (05) 523-528
    CrossrefPubMedGoogle Scholar
  • 7 Yeap MC, Tu PH, Liu ZH. et al. Long-term complications of cranioplasty using stored autologous bone graft, three-dimensional polymethyl methacrylate, or titanium mesh after decompressive craniectomy: a single-center experience after 596 procedures. World Neurosurg 2019; 128: e841-e850
    CrossrefPubMedGoogle Scholar
  • 8 Vince GH, Kraschl J, Rauter H, Stein M, Grossauer S, Uhl E. Comparison between autologous bone grafts and acrylic (PMMA) implants - a retrospective analysis of 286 cranioplasty procedures. J Clin Neurosci 2019; 61: 205-209
    CrossrefPubMedGoogle Scholar
  • 9 Hamböck M, Hosmann A, Seemann R. et al. The impact of implant material and patient age on the long-term outcome of secondary cranioplasty following decompressive craniectomy for severe traumatic brain injury. Acta Neurochir (Wien) 2020; 162 (04) 745-753
    CrossrefPubMedGoogle Scholar
  • 10 Hng D, Bhaskar I, Khan M. et al. Delayed cranioplasty: outcomes using frozen autologous bone flaps. Craniomaxillofac Trauma Reconstr 2015; 8 (03) 190-197
    CrossrefPubMedGoogle Scholar
  • 11 van de Vijfeijken SECM, Münker TJAG, Spijker R. et al; CranioSafe Group. Autologous bone is inferior to alloplastic cranioplasties: safety of autograft and allograft materials for cranioplasties, a systematic review. World Neurosurg 2018; 117: 443-452.e8
    CrossrefPubMedGoogle Scholar
  • 12 Moreira-Gonzalez A, Jackson IT, Miyawaki T, Barakat K, DiNick V. Clinical outcome in cranioplasty: critical review in long-term follow-up. J Craniofac Surg 2003; 14 (02) 144-153
    CrossrefPubMedGoogle Scholar
  • 13 Morina A, Kelmendi F, Morina Q. et al. Cranioplasty with subcutaneously preserved autologous bone grafts in abdominal wall-experience with 75 cases in a post-war country Kosova. Surg Neurol Int 2011; 2: 72
    CrossrefPubMedGoogle Scholar
  • 14 Im SH, Jang DK, Han YM, Kim JT, Chung DS, Park YS. Long-term incidence and predicting factors of cranioplasty infection after decompressive craniectomy. J Korean Neurosurg Soc 2012; 52 (04) 396-403
    CrossrefPubMedGoogle Scholar
  • 15 Matsuno A, Tanaka H, Iwamuro H. et al. Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochir (Wien) 2006; 148 (05) 535-540 , discussion 540
    CrossrefPubMedGoogle Scholar
  • 16 Lu Y, Hui G, Liu F, Wang Z, Tang Y, Gao S. Survival and regeneration of deep-freeze preserved autologous cranial bones after cranioplasty. Br J Neurosurg 2012; 26 (02) 216-221
    CrossrefPubMedGoogle Scholar
  • 17 Grossman N, Shemesh-Jan HS, Merkin V, Gideon M, Cohen A. Deep-freeze preservation of cranial bones for future cranioplasty: nine years of experience in Soroka University Medical Center. Cell Tissue Bank 2007; 8 (03) 243-246
    CrossrefPubMedGoogle Scholar
  • 18 Lee CH, Chung YS, Lee SH, Yang HJ, Son YJ. Analysis of the factors influencing bone graft infection after cranioplasty. J Trauma Acute Care Surg 2012; 73 (01) 255-260
    CrossrefPubMedGoogle Scholar
  • 19 Cheng YK, Weng HH, Yang JT, Lee MH, Wang TC, Chang CN. Factors affecting graft infection after cranioplasty. J Clin Neurosci 2008; 15 (10) 1115-1119
    CrossrefPubMedGoogle Scholar
  • 20 Henry J, Amoo M, Taylor J, O'Brien DP. Complications of cranioplasty in relation to material: systematic review, network meta-analysis and meta-regression. Neurosurgery 2021; 89 (03) 383-394
    CrossrefPubMedGoogle Scholar
  • 21 Liu L, Lu ST, Liu AH. et al. Comparison of complications in cranioplasty with various materials: a systematic review and meta-analysis. Br J Neurosurg 2020; 34 (04) 388-396
    CrossrefPubMedGoogle Scholar
  • 22 Maqbool T, Binhammer A, Binhammer P, Antonyshyn OM. Risk factors for titanium mesh implant exposure following cranioplasty. J Craniofac Surg 2018; 29 (05) 1181-1186
    CrossrefPubMedGoogle Scholar
  • 23 Grant GA, Jolley M, Ellenbogen RG, Roberts TS, Gruss JR, Loeser JD. Failure of autologous bone-assisted cranioplasty following decompressive craniectomy in children and adolescents. J Neurosurg 2004; 100 (2, Suppl Pediatrics) 163-168
    Google Scholar
  • 24 Kim SH, Kang DS, Cheong JH, Kim JH, Song KY, Kong MH. Comparison of complications following cranioplasty using a sterilized autologous bone flap or polymethyl methacrylate. Korean J Neurotrauma 2017; 13 (01) 15-23
    CrossrefPubMedGoogle Scholar
  • 25 Schuss P, Vatter H, Oszvald A. et al. Bone flap resorption: risk factors for the development of a long-term complication following cranioplasty after decompressive craniectomy. J Neurotrauma 2013; 30 (02) 91-95
    CrossrefPubMedGoogle Scholar
  • 26 Schuss P, Vatter H, Marquardt G. et al. Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J Neurotrauma 2012; 29 (06) 1090-1095
    CrossrefPubMedGoogle Scholar
  • 27 Walcott BP, Kwon C-S, Sheth SA. et al. Predictors of cranioplasty complications in stroke and trauma patients. J Neurosurg 2013; 118 (04) 757-762
    CrossrefPubMedGoogle Scholar
  • 28 Nasi D, Dobran M. Can early cranioplasty reduce the incidence of hydrocephalus after decompressive craniectomy? A meta-analysis. Surg Neurol Int 2020; 11: 94
    CrossrefPubMedGoogle Scholar
  • 29 Morselli C, Zaed I, Tropeano MP. et al. Comparison between the different types of heterologous materials used in cranioplasty: a systematic review of the literature. J Neurosurg Sci 2019; 63 (06) 723-736
    PubMedGoogle Scholar
  • 30 Xu H, Niu C, Fu X. et al. Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: a systematic review. Clin Neurol Neurosurg 2015; 136: 33-40
    CrossrefPubMedGoogle Scholar
  • 31 Malcolm JG, Mahmooth Z, Rindler RS. et al. Autologous cranioplasty is associated with increased reoperation rate: a systematic review and meta-analysis. World Neurosurg 2018; 116: 60-68
    CrossrefPubMedGoogle Scholar
  • 32 De Cola MC, Corallo F, Pria D, Lo Buono V, Calabrò RS. Timing for cranioplasty to improve neurological outcome: a systematic review. Brain Behav 2018; 8 (11) e01106
    CrossrefPubMedGoogle Scholar
  • 33 Malcolm JG, Rindler RS, Chu JK. et al. Early cranioplasty is associated with greater neurological improvement: a systematic review and meta-analysis. Neurosurgery 2018; 82 (03) 278-288
    CrossrefPubMedGoogle Scholar
  • 34 Zheng F, Xu H, von Spreckelsen N. et al. Early or late cranioplasty following decompressive craniotomy for traumatic brain injury: a systematic review and meta-analysis. J Int Med Res 2018; 46 (07) 2503-2512
    CrossrefPubMedGoogle Scholar
  • 35 Yadla S, Campbell PG, Chitale R, Maltenfort MG, Jabbour P, Sharan AD. Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review. Neurosurgery 2011; 68 (04) 1124-1129 , discussion 1130
    CrossrefPubMedGoogle Scholar