Introduction
Methods
Patient characteristics and study design
CP surgery
Follow-up
Statistical analysis
Results
Initial surgery (craniectomy)
Age | ||
Mean ± SD | 45 ± 15.9 years | |
Age categories | n | % |
0–30 years | 68 | 17.3 |
30–60 years | 268 | 68.4 |
> 60 years | 56 | 14.3 |
Gender | n | % |
Male | 210 | 53.3 |
Female | 182 | 46.7 |
Decompressive craniectomy (mean size 128 × 86.6 mm) | n | % |
Space-occupying cerebral infarction | 120 | 30.6 |
Traumatic brain injury | 104 | 26.5 |
Subarachnoid hemorrhage | 70 | 17.8 |
Spontaneous intracerebral hemorrhage | 33 | 8.4 |
Non-traumatic sub-/epidural hematoma | 6 | 1.5 |
Venous sinus thrombosis | 7 | 1.8 |
Craniectomy (mean size 82 × 66.6 mm) | n | % |
Infection | 34 | 8.7 |
Primary | 7 | 1.8 |
Secondary | 27 | 6.9 |
Tumor | 18 | 4.6 |
Technique | n | % |
Unilateral | 350 | 89.3 |
Bilateral | 7 | 1.8 |
Bifrontal | 17 | 4.3 |
Tumor craniectomy | 18 | 4.6 |
Cranioplasty
n | (%) | |
---|---|---|
Arterial hypertension | 177 | 45.1 |
Diabetes mellitus | 49 | 12.5 |
Other cardiovascular risk factors (e.g., coronary artery disease) | 113 | 28.8 |
Current smoker | 121 | 30.9 |
Drugs and/or alcohol abuse | 49 | 12.5 |
Renal insufficiency | 9 | 2.3 |
Liver cirrhosis | 25 | 6.4 |
Coagulation disorders | 19 | 4.8 |
Anticoagulant | 88 | 22.4 |
Platelet aggregation inhibitors | 86 | 21.9 |
Adiposities | 53 | 13.5 |
Cachexia | 3 | 0.7 |
Immunosuppression | 5 | 1.3 |
Multidrug-resistant bacteria (MDRB) | 56 | 14.3 |
Time between DC and CP | n | % |
Ultra early (< 30 days) | 11 | 2.8 |
Early (30–90 days) | 110 | 28.1 |
Late (90–180 days) | 156 | 39.8 |
Prolonged (> 180 days) | 82 | 20.9 |
Unknown | 12 | 3.1 |
Simultaneous craniectomy + CP | 21 | 5.4 |
Duration of CP surgery | ||
Primary CP | 131 ± 48 min | |
Revision CP | 159 ± 65 min | |
CSF shunt | n | % |
Before primary CP | 57 | 14.5 |
After primary CP | 17 | 4.3 |
Simultaneous shunt + CP | 15 | 3.8 |
During long-term follow-up | 5 | 1.3 |
Material | Primary CP | Revision CP | Total | |||
---|---|---|---|---|---|---|
n | % | n | % | n | % | |
Autologous bone | 289 | 73.7 | 2 | 1.7 | 291 | 57.3 |
PMMA manually (Palacos®) | 57 | 14.5 | 40 | 34.5 | 97 | 19.1 |
PMMA CAD/CAM (Biomet®) | 24 | 6.1 | 34 | 29.3 | 58 | 11.4 |
PEEK (CAD/CAM) | 14 | 35.7 | 28 | 24.1 | 42 | 8.2 |
Titanium mesh | 3 | 0.8 | 2 | 1.7 | 5 | 1 |
Titanium (CAD/CAM) | 5 | 1.3 | 10 | 8.6 | 15 | 3 |
Surgical details
Complication rates
Primary CP | Revision CP | |||
---|---|---|---|---|
n | % | n | % | |
Wound healing disorders | 15 | 3.8 | 11 | 9.5 |
Osteomyelitis/graft infection | 31 | 7.9 | 8 | 6.9 |
Bone flap osteolysis | 43 | 11.0 | – | – |
Loosening of CP | 15 | 3.8 | 5 | 4.3 |
CSF leakage | 6 | 1.5 | 1 | 0.8 |
Epidural/subdural hematoma | 12 | 3.1 | 10 | 8.7 |
Intracerebral hematoma | 1 | 0.2 | – | – |
Peri-/postoperative mortality | 1 | 0.2 | – | – |
Total | 130 | 33.2 | 37 | 32.2 |
Influencing factors
p value | OR | 95% KI | |
---|---|---|---|
Age | |||
0–30 years | 0.026* | 3.150 | 1.143–8.639 |
30–60 years | 0.386 | 1.434 | 0.634–3.242 |
> 60 years | 0.386 | 0.697 | 0.308–1.576 |
Patient-specific risk factors | |||
Nicotine | 0.441 | 1.280 | 0.683–2.396 |
Diabetes | 0.513 | 0.727 | 0.280–1.888 |
Fragmented autologous bone | 0.275 | 1.487 | 0.730–3.029 |
Multidrug-resistant bacteria | 0.045* | 2.273 | 1.018–5.074 |
Time between CPs | |||
< 30 days | 0.154 | 2.340 | 0.727–7.531 |
30–90 days | 0.635 | 0.809 | 0.337–1.942 |
90–180 days | 0.142 | 0.541 | 0.238–1.229 |
Others | |||
Surgery time for CP < 130 min | 0.870 | 1.050 | 0.583–1.892 |
Alloplastic CP CAD/CAM | 0.332 | 0.436 | 0.081–2.335 |
Alloplastic CP non CAD/CAM | 0.114 | 4.333 | 0.703–26.719 |
Implant fixation with miniplates | 0.013# | 0.310 | 0.123–0.781 |
Implant fixation with clamps | 0.336 | 1.611 | 0.609–4.259 |
CSF shunt | 0.001* | 3.137 | 1.613–6.101 |