Predictors of primary autograft cranioplasty survival and resorption after craniectomy

Author:

Korhonen Tommi K.12,Tetri Sami12,Huttunen Jukka3,Lindgren Antti3,Piitulainen Jaakko M.4,Serlo Willy5,Vallittu Pekka K.6,Posti Jussi P.678

Affiliation:

1. Department of Neurosurgery, Oulu University Hospital, Oulu;

2. Research Unit of Clinical Neuroscience, Neurosurgery, Oulu University Hospital and University of Oulu;

3. Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio;

4. Division of Surgery and Cancer Diseases, Department of Otorhinolaryngology–Head and Neck Surgery, Turku University Hospital, Turku Finland and University of Turku;

5. PEDEGO Research Unit, University of Oulu, MRC Oulu, and Department of Children and Adolescents, Oulu University Hospital, Oulu;

6. Department of Biomaterials Science, Institute of Dentistry, University of Turku and City of Turku, Welfare Division, Turku;

7. Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku; and

8. Department of Neurology, University of Turku, Finland

Abstract

OBJECTIVECraniectomy is a common neurosurgical procedure that reduces intracranial pressure, but survival necessitates cranioplasty at a later stage, after recovery from the primary insult. Complications such as infection and resorption of the autologous bone flap are common. The risk factors for complications and subsequent bone flap removal are unclear. The aim of this multicenter, retrospective study was to evaluate the factors affecting the outcome of primary autologous cranioplasty, with special emphasis on bone flap resorption.METHODSThe authors identified all patients who underwent primary autologous cranioplasty at 3 tertiary-level university hospitals between 2002 and 2015. Patients underwent follow-up until bone flap removal, death, or December 31, 2015.RESULTSThe cohort comprised 207 patients with a mean follow-up period of 3.7 years (SD 2.7 years). The overall complication rate was 39.6% (82/207), the bone flap removal rate was 19.3% (40/207), and 11 patients (5.3%) died during the follow-up period. Smoking (OR 3.23, 95% CI 1.50–6.95; p = 0.003) and age younger than 45 years (OR 2.29, 95% CI 1.07–4.89; p = 0.032) were found to independently predict subsequent autograft removal, while age younger than 30 years was found to independently predict clinically relevant bone flap resorption (OR 4.59, 95% CI 1.15–18.34; p = 0.03). The interval between craniectomy and cranioplasty was not found to predict either bone flap removal or resorption.CONCLUSIONSIn this large, multicenter cohort of patients with autologous cranioplasty, smoking and younger age predicted complications leading to bone flap removal. Very young age predicted bone flap resorption. The authors recommend that physicians extensively inform their patients of the pronounced risks of smoking before cranioplasty.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Genetics,Animal Science and Zoology

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