Download PDF
CC BY 4.0 · Indian Journal of Neurosurgery 2024; 13(01): 027-034
DOI: 10.1055/s-0043-1761603
Original Article

Complications of Different Types of Cranioplasty and Identification of Risk Factors Associated with Cranioplasty at a Tertiary Care Centre: A Prospective Observational Study

Yatendra Shukla
1   Department of Neurosurgery, Goa Medical College, Goa, India
,
Ponraj Kamatchi Sundaram 
1   Department of Neurosurgery, Goa Medical College, Goa, India
,
Jinendra Kumar Ramalingam 
1   Department of Neurosurgery, Goa Medical College, Goa, India
,
Jorson D. Costa
1   Department of Neurosurgery, Goa Medical College, Goa, India
,
Amey Parab
1   Department of Neurosurgery, Goa Medical College, Goa, India
,
Subhash Jakhar
1   Department of Neurosurgery, Goa Medical College, Goa, India
,
Ganesh Chauhan 
2   Rajendra Institute of Medical Sciences, Ranchi, India
,
Rohit Bharti 
1   Department of Neurosurgery, Goa Medical College, Goa, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective Decompressive craniectomy (DC) is an urgent procedure which is done to decrease intracranial pressure. A study of the complications would suggest measures to improve the care. This study was focused on analyzing the complications after cranioplasty (CP) and to identify risk factors that may be associated with the failure of the procedure.

Method: This study was conducted over 41 months at level-1 trauma center and medical college. It included patients undergoing CP for a defect arising out of previous DC or inability to replace the bone flap (Glasgow Coma Scale > 13, size > 5 cm, without surgical site infection). All patients underwent CT imaging before and after the procedure. The CP technique largely depended on the patients, based on the cost of prosthesis and availability.

Result: Hundred patients were included in the study. Postoperatively, total 22 patients suffered complications of which few had more than one complication. Titanium implant appeared to be a better implant, with no complication (p < 0.05). Complication was common in younger age group, chemically cured PMMA (polymethyl methacrylate) and ethylene oxide) sterilized bone flap). Complications were higher among patients with multiple comorbidity and stroke patients.

Conclusion: Titanium flap had no complication and in case of autologous abdominal subcutaneous flap, apart from bone flap absorption, patients had no major complication. Therefore, both implants are preferred implants for CP. Heat-cured PMMA can be used in case of nonavailability of a better option, as it is economical feasible and can be molded at any dental lab.

Keywords

Decompressive craniectomy - cranioplasty - infection - titanium - methyl methacrylate


Publication History

Article published online:
23 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Hutchinson P, Timofeev I, Kirkpatrick P. Surgery for brain edema. Neurosurg Focus 2007; 22 (05) E14
    CrossrefPubMedGoogle Scholar
  • 2 Ducic Y. Titanium mesh and hydroxyapatite cement cranioplasty: a report of 20 cases. J Oral Maxillofac Surg 2002; 60 (03) 272-276
    CrossrefPubMedGoogle Scholar
  • 3 Kriegel RJ, Schaller C, Clusmann H. Cranioplasty for large skull defects with PMMA (polymethylmethacrylate) or tutoplast processed autogenic bone grafts. Zentralbl Neurochir 2007; 68 (04) 182-189
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Flannery T, McConnell RS. Cranioplasty: why throw the bone flap out?. Br J Neurosurg 2001; 15 (06) 518-520
    CrossrefPubMedGoogle Scholar
  • 5 Nievas MNCY, Höllerhage H-G. Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders. Neurol Res 2006; 28 (02) 139-144
    CrossrefPubMedGoogle Scholar
  • 6 Liang W, Xiaofeng Y, Weiguo L. et al. Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head trauma. J Craniofac Surg 2007; 18 (03) 526-532
    CrossrefPubMedGoogle Scholar
  • 7 Gooch MR, Gin GE, Kenning TJ, German JW. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 2009; 26 (06) E9
    CrossrefPubMedGoogle Scholar
  • 8 Chaturvedi J, Botta R, Prabhuraj AR, Shukla D, Bhat DI, Devi BI. Complications of cranioplasty after decompressive craniectomy for traumatic brain injury. Br J Neurosurg 2016; 30 (02) 264-268
    PubMedGoogle Scholar
  • 9 Chang V, Hartzfeld P, Langlois M, Mahmood A, Seyfried D. Outcomes of cranial repair after craniectomy. J Neurosurg 2010; 112 (05) 1120-1124
    CrossrefPubMedGoogle Scholar
  • 10 Piedra MP, Thompson EM, Selden NR, Ragel BT, Guillaume DJ. Optimal timing of autologous cranioplasty after decompressive craniectomy in children. J Neurosurg Pediatr 2012; 10 (04) 268-272
    CrossrefPubMedGoogle Scholar
  • 11 Zanaty M, Chalouhi N, Starke RM. et al. Complications following cranioplasty: incidence and predictors in 348 cases. J Neurosurg 2015; 123 (01) 182-188
    CrossrefPubMedGoogle Scholar
  • 12 De Bonis P, Frassanito P, Mangiola A, Nucci CG, Anile C, Pompucci A. Cranial repair: how complicated is filling a “hole”?. J Neurotrauma 2012; 29 (06) 1071-1076
    CrossrefPubMedGoogle Scholar
  • 13 Schuss P, Vatter H, Marquardt G. et al. Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J Neurotrauma 2012; 29 (06) 1090-1095
    CrossrefPubMedGoogle Scholar
  • 14 Lee JW, Kim JH, Kang HI, Moon BG, Lee SJ, Kim JS. Epidural fluid collection after cranioplasty: fate and predictive factors. J Korean Neurosurg Soc 2011; 50 (03) 231-234
    CrossrefPubMedGoogle Scholar
  • 15 Becker LC, Bergfeld WF, Belsito DV. et al. Final report of the cosmetic ingredient review expert panel safety assessment of polymethyl methacrylate (PMMA), methyl methacrylate crosspolymer, and methyl methacrylate/glycol dimethacrylate crosspolymer. Int J Toxicol 2011; 30 (3, Suppl): 54S-65S
    CrossrefPubMedGoogle Scholar
  • 16 Malcolm JG, Rindler RS, Chu JK, Grossberg JA, Pradilla G, Ahmad FU. Complications following cranioplasty and relationship to timing: a systematic review and meta-analysis. J Clin Neurosci 2016; 33: 39-51
    CrossrefPubMedGoogle Scholar
  • 17 Walcott BP, Kwon CS, Sheth SA. et al. Predictors of cranioplasty complications in stroke and trauma patients. J Neurosurg 2013; 118 (04) 757-762
    CrossrefPubMedGoogle Scholar
  • 18 Farace E, Alves WM. Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg 2000; 93 (04) 539-545
    CrossrefPubMedGoogle Scholar
  • 19 Lee MK, Sakai O, Spiegel JH. CT measurement of the frontal sinus—gender differences and implications for frontal cranioplasty. J Craniomaxillofac Surg 2010; 38 (07) 494-500
    CrossrefPubMedGoogle Scholar
  • 20 Yadla S, Campbell PG, Chitale R, Maltenfort MG, Jabbour P, Sharan AD. Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review. Neurosurgery 2011; 68 (04) 1124-1129 , discussion 1130
    CrossrefPubMedGoogle Scholar
  • 21 Klinger DR, Madden C, Beshay J, White J, Gambrell K, Rickert K. Autologous and acrylic cranioplasty: a review of 10 years and 258 cases. World Neurosurg 2014; 82 (3-4): e525-e530
    CrossrefPubMedGoogle Scholar
  • 22 Cheng C-H, Lee H-C, Chen C-C, Cho D-Y, Lin H-L. Cryopreservation versus subcutaneous preservation of autologous bone flaps for cranioplasty: comparison of the surgical site infection and bone resorption rates. Clin Neurol Neurosurg 2014; 124: 85-89
    CrossrefPubMedGoogle Scholar
  • 23 Brommeland T, Rydning PN, Pripp AH, Helseth E. Cranioplasty complications and risk factors associated with bone flap resorption. Scand J Trauma Resusc Emerg Med 2015; 23: 75
    CrossrefPubMedGoogle Scholar
  • 24 Tsang AC-O, Hui VK-H, Lui W-M, Leung GK. Complications of post-craniectomy cranioplasty: risk factor analysis and implications for treatment planning. J Clin Neurosci 2015; 22 (05) 834-837
    CrossrefPubMedGoogle Scholar
  • 25 Bender A, Heulin S, Röhrer S. et al. Early cranioplasty may improve outcome in neurological patients with decompressive craniectomy. Brain Inj 2013; 27 (09) 1073-1079
    CrossrefPubMedGoogle Scholar
  • 26 Prasad GL, Menon GR, Kongwad LI, Kumar V. Outcomes of cranioplasty from a tertiary hospital in a developing country. Neurol India 2020; 68 (01) 63-70
    CrossrefPubMedGoogle Scholar
  • 27 Cheng Y-K, Weng H-H, Yang J-T, Lee M-H, Wang T-C, Chang C-N. Factors affecting graft infection after cranioplasty. J Clin Neurosci 2008; 15 (10) 1115-1119
    CrossrefPubMedGoogle Scholar
  • 28 Kim SP, Kang DS, Cheong JH, Kim JH, Song KY, Kong MH. Clinical analysis of epidural fluid collection as a complication after cranioplasty. J Korean Neurosurg Soc 2014; 56 (05) 410-418
    CrossrefPubMedGoogle Scholar
  • 29 Thavarajah D, De Lacy P, Hussien A, Sugar A. The minimum time for cranioplasty insertion from craniectomy is six months to reduce risk of infection—a case series of 82 patients. Br J Neurosurg 2012; 26 (01) 78-80
    CrossrefPubMedGoogle Scholar
  • 30 Chalmers J, Gray DH, Rush J. Observations on the induction of bone in soft tissues. J Bone Joint Surg Br 1975; 57 (01) 36-45
    CrossrefPubMedGoogle Scholar