J Neurointensive Care.  2020 Oct;3(2):48-57. 10.32587/jnic.2020.00290.

Optimal Timing and Complications of Cranioplasty: A Single-Center Retrospective Review of 109 Cases

• Kim YM
• Park T
• Lee SP
• Baek Jw
• Ryou KS
• Kim SH

• KMID: 2555039
• DOI: http://doi.org/10.32587/jnic.2020.00290

Abstract

Objective
Cranioplasty is the surgical reparation of decompressive craniectomy. Although cranioplasty is performed for cosmetic and functional benefits, and is a simple surgical procedure, it is usually associated with a relatively high complication rate, ranging from 10% to 50%.
Methods
This was a retrospective review of 109 patients who had undergone a cranioplasty over a period of 10 years. At our institution, the time period were classified into very early (<30 days), early (between 30-60 days), late (between 60-90 days), and more late (>90 days) interventions based on the time period before cranioplasty. We evaluated postoperative complications and the relationship between their occurrence and the timing of the cranioplasty.
Results
The overall complication rate in this study was 44%. Hydrocephalus was the most common complication (34.9%), followed by infections (6.4%), hematoma (4.6%), and others such as seizure (0.9%) and headache (0.9%). Infections were the only complications whose incidence increased with the early timing of the cranioplasty. The incidence of hematoma increased with the late timing of cranioplasty and was probably a result of its prolonged operation time (p=0.007). The incidence of hydrocephalus was not associated with cranioplasty timing but the indication of craniectomy and the number of revision surgeries performed before cranioplasty. (p=0.046)
Conclusion
Cranioplasty is associated with high rate of complication and the incidence of the complications vary with the timing of the operation. There are many advantages of early cranioplasty that can be redeemed if strict measures are taken, while performing the surgery, to prevent postoperative infections.

Keyword

Cranioplasty; Complication; Optimal Timing; Infection; Hydrocephalus