Introduction
Methods
Patient population
Cranioplasty
Data collection
Data analysis
Results
Patient characteristics
Characteristics | Total (n = 145) | Without complication (n = 112) | With complication (n = 33) | p valuea |
---|---|---|---|---|
Gender, female, n (%) | 78 (54) | 60 (54) | 18 (55) | |
Age, mean ± SD | 44.3 ± 14.7 | 43.4 ± 14.8 | 47.3 ± 14.0 | |
History | ||||
Hypertension, n (%) | 29 (20) | 23 (21) | 6 (18) | |
Diabetes mellitus, n (%) | 6 (4) | 6 (5) | 0 | |
Ischemic heart disease, n (%) | 7 (5) | 6 (5) | 1 (3) | |
Antiplatelet agent, n (%) | 15 (10) | 12 (11) | 3 (9) | |
Gore-tex® skin plasty during DC | 5 (3) | 3 (3) | 2 (6) | |
Surgery between DC and cranioplasty, n (%) | 37 (25) | 25 (22) | 12 (36) | |
Etiology of DC | 0.012 | |||
Infarction, n (%) | 51 (35) | 46 (41) | 5 (15) | 0.009 |
SAH, n (%) | 29 (20) | 20 (18) | 9 (27) | |
TBI: | ||||
aSDH, n (%) | 13 (9) | 4 (4) | 9 (27) | < 0.001 |
aEDH, n (%) | 6 (4) | 5 (4) | 1 (3) | |
Contusion, n (%) | 6 (4) | 4 (4) | 2 (6) | |
Gunshot, n (%) | 2 (1) | 2 (2) | 0 | |
ICH, n (%) | 21 (15) | 16 (14) | 5 (15) | |
CVT, n (%) | 13 (9) | 12 (11) | 1 (3) | |
Infection, n (%) | 2 (1) | 2 (2) | 0 | |
Tumor, n (%) | 2 (1) | 1 (1) | 1 (3) | |
Left side of cranioplasty, n (%) | 66 (45) | 50 (45) | 16 (49) | |
Bifrontal cranioplasty, n (%) | 4 (3) | 3 (3) | 1 (3) | |
Pre-CP symptomatic CSF disturbance, n (%) | 32 (22) | 18 (16) | 14 (42) | 0.002 |
Pre-CP VP shunt, n (%) | 6 (4) | 4 (4) | 2 (6) | |
Not closed | 4 | 4 | 0 | |
Programmable valve at highest resistance | 2 | 0 | 2 | |
Pre-CP not closed LP shunt, n (%) | 2 (1) | 1 (1) | 1 (3) | |
Pre-CP closed EL-shunt | 3 (1) | 3 (3) | 0 | |
Pre-CP closed EV-shunt, n (%) | 9 (6) | 4 (4) | 5 (15) | |
No drain in situ pre-CPb | 12 (8) | 6 (5) | 6 (18) | |
DC-CP interval | ||||
Median days (IQR) | 136 (91–210) | 141 (103–217) | 101 (47–168) | 0.008 |
≤ 3 months, n (%) | 37 (26) | 22 (20) | 15 (46) | 0.004 |
Residence pre-CP | ||||
During initial hospitalization for DC, n (%) | 31 (21) | 17 (15) | 14 (42) | 0.001 |
At a RC, n (%) | 52 (36) | 46 (41) | 6 (18) | |
At a nursing home, n (%) | 15 (10) | 10 (9) | 5 (15) | |
At home, n (%) | 47 (32) | 39 (35) | 8 (24) | |
Pre-CP CT finding in 75 patients | ||||
Midline-shift, mm, median (IQR) | 3 (2–6) | 3 (2–6) | 3 (2–8) | |
Sunken ratio, mean ± SDc | 1.05 ± 0.20 | 1.07 ± 0.18 | 0.99 ± 0.26 | |
Surgical expertise | ||||
Resident + attending, n (%) | 114 (79) | 87 (78) | 27 (82) | |
Attending, n (%) | 31 (21) | 25 (22) | 6 (18) | |
CP management (n = 137d) | ||||
Intraoperative lumbar/ventricular drainagee | 38 (28) | 26 (25) | 12 (38) | |
< 3 central tack-up sutures | 105 (77) | 80 (76) | 25 (78) | |
Graft fixation | ||||
Non-absorbable sutures | 34 (25) | 26 (25) | 8 (25) | |
Titanium osteoplastic plates/screws | 67 (49) | 48 (46) | 19 (59) | |
Titanium Craniofix (Aesculap AG) | 36 (26) | 31 (30) | 5 (16) | |
Epidural/subgaleal drainf | 40 (29) | 32 (31) | 8 (25) | |
Using artificial bone, n (%) | 33 (23) | 23 (21) | 10 (30) | |
Hospital stay post-CP, days, median (IQR) | 3 (2–8) | 3 (2–4) | 15 (6–32) | < 0.001 |
Predictors of complications
Complication | Number of patients (% of total) |
---|---|
Postoperative hemorrhage | 18 (12) |
Symptomatic EDH | 17 |
Evacuation of EDH | 16 |
Died due to EDH | 1 |
Symptomatic SDH, with evacuation | 1 |
Postoperative infection, with removal of the graft | 10 (7) |
Hygroma requiring burr hole drainage | 4 (3) |
Hydrocephalus requiring VP shunt placement | 1 (1) |
Timing of cranioplasty
Characteristics | CP ≤ 3 months n = 37 | CP > 3 months n = 108 | p valuea |
---|---|---|---|
Gender, female, n (%) | 24 (65) | 54 (50) | |
Age, mean ± SD | 43.4 ± 16.3 | 44.6 ± 14.1 | |
Pre-CP CSF disturbance, n (%) | 20 (54) | 12 (11) | < 0.0001 |
aSDH as etiology of DC, n (%) | 10 (27) | 3 (3) | < 0.0001 |
CP during initial hospitalization for DC, n (%) | 29 (78) | 2 (2) | < 0.0001 |
Complication, n (%) | 15 (41) | 18 (17) | 0.004 |
Postoperative hemorrhage, n (%) | 8 (22) | 10 (9) | |
Postoperative infection, n (%) | 3 (8) | 7 (6) |