Routine but risky: A multi-centre analysis of the outcomes of cranioplasty in the Northeast of England

Abstract

Cranioplasty harbours significant morbidity, a risk that appears to be higher with a bifrontal defect. The complications experienced influence subsequent functional outcome. The timing of cranioplasty, early or late, after the initial operation does not impact on the ultimate outcome. These findings should be considered when making decisions relating to craniectomy and cranioplasty.

A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty

“…3,9,20,26 Within the Western Australian statewide neurosurgical service, the overall infection rate for cranial procedures has been consistently audited at 1%-2%; however, our previous studies have also demonstrated a high cranioplasty infection rate, consistent with some other reports. 13,17 It is unknown why it is so high; a number of reasons have been proposed, including skin colonization while in the hospital, uncertain sterility with long-term storage of the bone flap, and reduced immune response following major brain injury trauma and reop- eration.…”

Autologous Cranioplasty Post-Operative Surgical Site Infection: Does It Matter if the Bone Flaps were Stored and Handled Differently?

“…The study found that the incidence of SSI in cranioplasty using the autologous bone flap method at the two studied centres was 5.9% in 101 patients within a period of 18 months. This finding is consistent with previously reported rates of infection, ranging between 7% and 22% (10)(11). The rate of postcranioplasty SSI was 5.5% and 6.5% for the cryopreserved bone flaps and the bone flaps stored in the abdominal subcutaneous pocket, respectively.…”

Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: A systematic review

“…Though CP is a regular surgery, it has many complications, including CNS infection, hydrocephalus, intracranial hematoma and subdural fluid collection, which will prolong the hospitalization, lead to unfavorable prognosis and even death [11]. Because of the allograft materials implantation, the risk of infection is relatively magnified in CP compared with other neurosurgical operations.…”

“…Decompressive craniotomy (DC) -a surgical procedure that involves the removal of part of the skull to accommodate brain swelling -has been used for many years in the management of patients with brain edema and/or intracranial hypertension due to subarachnoid hemorrhage, traumatic brain injury, cerebral infarction, intracerebral hemorrhage (ICH), and other causes [1,11,18,20]. Since more patients survive because of the DC surgery, the number of subsequent cranioplasty (CP) procedures is increasing.…”