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Meta-Analysis
. 2021 Dec;44(6):3125-3142.
doi: 10.1007/s10143-021-01511-7. Epub 2021 Mar 8.

Complications of cranioplasty in relationship to traumatic brain injury: a systematic review and meta-analysis

David Shepetovsky  1 , Gianluca Mezzini  1 , Lorenzo Magrassi  2   3
Affiliations
Meta-Analysis

Complications of cranioplasty in relationship to traumatic brain injury: a systematic review and meta-analysis

David Shepetovsky et al. Neurosurg Rev. 2021 Dec.

Abstract

Despite being a common procedure, cranioplasty (CP) is associated with a variety of serious, at times lethal, complications. This study explored the relationship between the initial injury leading to decompressive craniectomy (DC) and the rates and types of complications after subsequent CP. It specifically compared between traumatic brain injury (TBI) patients and patients undergoing CP after DC for other indications.A comprehensive search of PubMed, Scopus, and the Cochrane Library databases using PRISMA guidelines was performed to include case-control studies, cohorts, and clinical trials reporting complication data for CP after DC. Information about the patients' characteristics and the rates of overall and specific complications in TBI and non-TBI patients was extracted, summarized, and analyzed.A total of 59 studies, including the authors' institutional experience, encompassing 9264 patients (4671 TBI vs. 4593 non-TBI) met the inclusion criteria; this total also included 149 cases from our institutional series. The results of the analysis of the published series are shown both with and without our series 23 studies reported overall complications, 40 reported infections, 10 reported new-onset seizures, 13 reported bone flap resorption (BFR), 5 reported post-CP hydrocephalus, 10 reported intracranial hemorrhage (ICH), and 8 reported extra-axial fluid collections (EFC). TBI was associated with increased odds of BFR (odds ratio [OR] 1.76, p < 0.01) and infection (OR 1.38, p = 0.02). No difference was detected in the odds of overall complications, seizures, hydrocephalus, ICH, or EFC.Awareness of increased risks of BFR and infection after CP in TBI patients promotes the implementation of new strategies to prevent these complications especially in this category of patients.

Keywords: Complications; Cranioplasty; Decompressive craniectomy; Traumatic brain injury.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of literature search strategy and article selection
Fig. 2
Fig. 2
Forest plot of studies reporting overall cranioplasty complications in TBI and non-TBI patients
Fig. 3
Fig. 3
Forest plot of studies reporting new-onset post-cranioplasty seizures in TBI and non-TBI patients
Fig. 4
Fig. 4
Forest plot of studies reporting post-cranioplasty intracranial hemorrhage in TBI and non-TBI patients
Fig. 5
Fig. 5
Forest plot of studies reporting post-cranioplasty extra-axial fluid collections in TBI and non-TBI patients
Fig. 6
Fig. 6
Forest plot of studies reporting post-cranioplasty infection in TBI and non-TBI patients
Fig. 7
Fig. 7
Forest plot of studies reporting post-cranioplasty hydrocephalus in TBI and non-TBI patients
Fig. 8
Fig. 8
Forest plot of studies reporting post-cranioplasty bone flap resorption in TBI and non-TBI patients
See this image and copyright information in PMC

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