A multicenter cohort study of early complications after cranioplasty: results of the German Cranial Reconstruction Registry

Abstract

OBJECTIVE Cranioplasty (CP) is a crucial procedure after decompressive craniectomy and has a significant impact on neurological improvement. Although CP is considered a standard neurosurgical procedure, inconsistent data on surgery-related complications after CP are available. To address this topic, the authors analyzed 502 patients in a prospective multicenter database (German Cranial Reconstruction Registry) with regard to early surgery-related complications. METHODS Early complications within 30 days, medical history, mortality rates, and neurological outcome at discharge according to the modified Rankin Scale (mRS) were evaluated. The primary endpoint was death or surgical revision within the first 30 days after CP. Independent factors for the occurrence of complications with or without surgical revision were identified using a logistic regression model. RESULTS Traumatic brain injury (TBI) and ischemic stroke were the most common underlying diagnoses that required CP. In 230 patients (45.8%), an autologous bone flap was utilized for CP; the most common engineered materials were titanium (80 patients [15.9%]), polyetheretherketone (57 [11.4%]), and polymethylmethacrylate (57 [11.4%]). Surgical revision was necessary in 45 patients (9.0%), and the overall mortality rate was 0.8% (4 patients). The cause of death was related to ischemia in 2 patients, diffuse intraparenchymal hemorrhage in 1 patient, and cardiac complications in 1 patient. The most frequent causes of surgical revision were epidural hematoma (40.0% of all revisions), new hydrocephalus (22.0%), and subdural hematoma (13.3%). Preoperatively increased mRS score (OR 1.46, 95% CI 1.08–1.97, p = 0.014) and American Society of Anesthesiologists Physical Status Classification System score (OR 2.89, 95% CI 1.42–5.89, p = 0.003) were independent predictors of surgical revision. Ischemic stroke, as the underlying diagnosis, was associated with a minor rate of revisions compared with TBI (OR 0.18, 95% CI 0.06–0.57, p = 0.004). CONCLUSIONS The authors have presented class II evidence–based data on surgery-related complications after CP and have identified specific preexisting risk factors. These results may provide additional guidance for optimized treatment of these patients.

Analysis of PMMA versus CaP titanium-enhanced implants for cranioplasty after decompressive craniectomy: a retrospective observational cohort study

“…This is also confirmed by the small number of prospective clinical trials performed to date [20,21]. However, prospective registries (e.g., German Cranial Reconstruction Registry) bear the potential of longitudinal multicentric analyses with homogenous datasets [16,38]. First data from the Multicenter Prospective Registry of Cranioplasty in the UK and Ireland offers insights into international variation in practice [15].…”

“…Although the surgical procedure is relatively straightforward, it is associated with substantial cost and morbidity [44]. Complications include post-operative bleeding, seizures, meningitis, surgical site infection (SSI), and bone flap resorption (BFR) [6,10,38,42]. Uncertainty persists regarding the implications of the timing of cranioplasty in terms of complication rates and potential benefits [2,3,40,45].…”

A Comparative Analysis of PMMA Versus CaP Titanium-Enhanced Implants for Cranioplasty After Decompressive Craniectomy

“…However prospective registries (e.g. German Cranial Reconstruction Registry) bear the potential of longitudinal multicentric analyses with homogenous datasets [14,31].…”

“…Although the surgical procedure is relatively straightforward, it is associated with substantial cost and morbidity [38]. Complications include post-operative bleeding, seizures, meningitis, surgical site infection (SSI), and bone ap resorption (BFR) [5,9,31,37]. Uncertainty persists regarding the implications of the timing of CP in terms of complication rates and potential bene ts [2,3,35,39].…”

Optimal Timing of Cranioplasty and Predictors of Overall Complications After Cranioplasty: The Impact of Brain Collapse

“…[11][12][13][14][15][16][17] As a regular procedure after DC, CP is associated with a high incidence of postoperative complications, including infection, epidural hematoma, ICH, hydrocephalus, seizure, and epidural/ subdural fluid collections. [18][19][20][21][22][23][24] Many studies suggest that the DC-CP interval and surgery materials may be related to complications after CP. [25][26][27] Whereas factors influencing postoperative complications remain controversial, there are very few reports concerning the relationship between brain collapse and postoperative complications.…”