Autologous and acrylic cranioplasty: a review of 10 years and 258 cases

Abstract

Introduction: Cranioplasty is a well-accepted neurosurgical procedure that has application to a wide range of pathologies. Given the varied need for both autologous and synthetic cranial grafts, it is important to establish rates of procedural complication.

Methods: A retrospective review identified 282 patients undergoing cranioplasty at our institution over a 10-year period, of which 249 patients underwent 258 cranioplasties with either autologous or acrylic flaps. A database including patient age, gender, presenting diagnosis, hospital of surgery, presence of a drain, and surgical complications was created in order to analyze the autologous and acrylic cranioplasty data.

Results: A total of 28 complications were noted, yielding a rate of 10.9% (28/258). There was no statistically significant difference in infection rate between autologous and acrylic cranioplasty (7.2% vs. 5.8%, P=0.80). Male patients (P=0.007), tumor patients (P=0.02), and patients undergoing surgery at the county hospital (P=0.06) sustained a statistically higher rate of infection. Among traumatic brain injury patients, complex injuries and surgical involvement of the frontal sinus carried a significantly higher infection rate of 17% and 38.5%, respectively (P=0.03, P=0.001). Postoperative epidural hematoma requiring reoperation occurred in 3.5% (9/258) with no difference in hematoma rate with placement of a drain (P=1).

Conclusions: Cranioplasty carries a significant risk of infection and postoperative hematoma. In this large series comparing autologous and acrylic flaps, male patients, tumor patients, and those undergoing surgery at the county hospital were at increased risk of postoperative infection. Among traumatic brain injury cases, complex injuries and cases with surgical involvement of the frontal sinus may portend a higher risk.

Keywords: Cranioplasty; Craniotomy/craniectomy; Hemorrhage; Infection; Traumatic brain injury.