Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jun;45(3):1915-1922.
doi: 10.1007/s10143-022-01737-z. Epub 2022 Jan 21.

A systematic review and meta-analysis of factors involved in bone flap resorption after decompressive craniectomy

Francesco Signorelli  1 , Martina Giordano  2 , Valerio Maria Caccavella  3   4 , Eleonora Ioannoni  5 , Camilla Gelormini  5 , Anselmo Caricato  5 , Alessandro Olivi  1   2 , Nicola Montano  1   2
Affiliations
Meta-Analysis

A systematic review and meta-analysis of factors involved in bone flap resorption after decompressive craniectomy

Francesco Signorelli et al. Neurosurg Rev. 2022 Jun.

Abstract

Decompressive craniectomy (DC) is effective in controlling increasing intracranial pressure determined by a wide range of conditions, mainly traumatic brain injury (TBI) and stroke, and the subsequent cranioplasty (CP) displays potential therapeutic benefit in terms of overall neurological function. While autologous bone flap (ABF) harvested at the time of DC is the ideal material for skull defect reconstruction, it carries several risks. Aseptic bone flap resorption (BFR) is one of the most common complications, often leading to surgical failure. The aim of our study was to systematically review the literature and carry out a meta-analysis of possible factors involved in BFR in patients undergoing ABF cranioplasty after DC. A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Different medical databases (PubMed, Embase, and Scopus) were screened for eligible scientific reports until April 30th 2021. The following data were collected for meta-analysis to assess their role in BFR: sex, age, the interval time between DC and CP, the presence of systemic factors, the etiology determining the DC, CP surgical time, CP features, VP shunt placement, CP infection. Studies including pediatric patients or with less than 50 patients were excluded. Fifteen studies were included. There was a statistically significant increased incidence of BFR in patients with CPF > 2 compared to patients with CPF ≤ 2 (54.50% and 22.76% respectively, p = 0.010). TBI was a significantly more frequent etiology in the BFR group compared to patients without BFR (61.95% and 47.58% respectively, p < 0.001). Finally, patients with BFR were significantly younger than patients without BFR (39.12 ± 15.36 years and 47.31 ± 14.78 years, respectively, p < 0.001). The funnel plots were largely symmetrical for all the studied factors. Bone flap fragmentation, TBI etiology, and young age significantly increase the risk of bone resorption. Further studies are needed to strengthen our results and to clarify if, in those cases, a synthetic implant for primary CP should be recommended.

Keywords: Aseptic bone flap resorption; Cranioplasty; Decompressive craniectomy; Ischemic stroke; Traumatic brain injury.

PubMed Disclaimer

Comment in

References

    1. Agrawal A, Sabharawal G, Rajendra P, Mathew T (2009) Characteristics of associated craniofacial trauma in patients with head injuries: an experience with 100 cases. J Emergencies Trauma Shock 2:89. https://doi.org/10.4103/0974-2700.50742 - DOI
    1. Artico M, Ferrante L, Pastore FS, Ramundo EO et al (2003) Bone autografting of the calvaria and craniofacial skeleton. Surg Neurol 60:71–79. https://doi.org/10.1016/S0090-3019(03)00031-4 - DOI - PubMed
    1. Bhaskar IP, Inglis TJJ, Lee GYF (2014) Clinical, radiological, and microbiological profile of patients with autogenous cranioplasty infections. World Neurosurg 82:e531–e534. https://doi.org/10.1016/j.wneu.2013.01.013 - DOI - PubMed
    1. Bowers CA, Riva-Cambrin J, Hertzler DA, Walker ML (2013) Risk factors and rates of bone flap resorption in pediatric patients after decompressive craniectomy for traumatic brain injury. J Neurosurg Pediatr 11:526–532. https://doi.org/10.3171/2013.1.PEDS12483 - DOI - PubMed
    1. Brommeland T, Rydning PN, Pripp AH, Helseth E (2015) Cranioplasty complications and risk factors associated with bone flap resorption. Scand J Trauma Resusc Emerg Med 23:75. https://doi.org/10.1186/s13049-015-0155-6 - DOI - PubMed - PMC

MeSH terms

LinkOut - more resources