Cranioplasty Outcomes From 500 Consecutive Neuroplastic Surgery Patients

Abstract

Background: Cranioplasty is critical to cerebral protection and restoring intracranial physiology, yet this procedure is fraught with a high risk of complications. The field of neuroplastic surgery was created to improve skull and scalp reconstruction outcomes in adult neurosurgical patients, with the hypothesis that a multidisciplinary team approach could help decrease complications. Objective: To determine outcomes from a cohort of cranioplasty surgeries performed by a neuroplastic surgery team using a consistent surgical technique and approach. Methods: The authors reviewed 500 consecutive adult neuroplastic surgery cranioplasties that were performed between January 2012 and September 2020. Data were abstracted from a prospectively maintained database. Univariate analysis was performed to determine association between demographic, medical, and surgical factors and odds of revision surgery. Results: Patients were followed for an average of 24 months. Overall, there was a reoperation rate of 15.2% (n = 76), with the most frequent complications being infection (7.8%, n = 39), epidural hematoma (2.2%, n = 11), and wound dehiscence (1.8%, n = 9). New onset seizures occurred in 6 (1.2%) patients. Several variables were associated with increased odds of revision surgery, including lower body mass ratio, 2 or more cranial surgeries, presence of hydrocephalus shunts, scalp tissue defects, large-sized skull defect, and autologous bone flaps. importantly, implants with embedded neurotechnology were not associated with increased odds of reoperation. Conclusions: These results allow for comparison of multiple factors that impact risk of complications after cranioplasty and lay the foundation for development of a cranioplasty risk stratification scheme. Further research in neuroplastic surgery is warranted to examine how designated centers concentrating on adult neuro-cranial reconstruction and multidisciplinary collaboration may lead to improved cranioplasty outcomes and decreased risks of complications in neurosurgical patients.

Prognosis-Guided Reconstruction of Scalp and Skull Defects in Neurosurgical Patients

“…One hundred seventy-one patients who underwent 418 procedures were included (median, 1 [1][2][3] surgeries per patient). Average age was 55 ± 15 years; 53% of patients were male (Table 1).…”

“…In 79%, plastic surgery was consulted a median of 340 days [96-1313 days] after their first neurosurgery (related to presenting pathology). These patients underwent a median of 2 [2][3] prior neurosurgeries. One-third of patients had no history of neurosurgical procedures before combined neurosurgery and plastic surgery intervention.…”

“…Belzberg et al 2 found a reoperation rate of 15.2% after cranioplasty in 500 neuroplastic surgery patients with infection (7.8%), epidural hematoma (2.2%), and wound dehiscence (1.8%) being the most common complications in their series. Comparably, we found a postoperative infection rate of 9% (n = 35), although our most common complication was titanium hardware exposure (36%).…”

Skull and Scalp En-Bloc Harvest Protects Calvarial Perfusion: A Cadaveric Study

“…3 Thus, an ideal biomaterial for cranioplasty has yet to be identified to address what remains a significant clinical challenge/need. 8,9 Calvarial transplantation offers the potential opportunity to address skull defect form and functional needs by replacing "like-with-like" tissue but remains poorly investigated.…”

Discussion on: “Let’s Smarten Up: Smart Devices and the Internet of Things, an Untapped Resource for Innovation in Craniofacial Surgery”

“…We can and should recognize that the pendulum is now swinging back the other direction. There are many high-level papers demonstrating statistical evidence that FDA-approved, alloplastic implants placed correctly and in sound fashion will accompany a lower rate of complications, including infection and/or the need for revision surgery 11…”