gms | German Medical Science

Objective: The aim of the study is to investigate whether predictors of surgical complications are identifiable in a group of 219 patients after decompressive craniectomy due to different indications.

Methods: The hospital’s electronic database was reviewed. Two hundred and thirty patients with cranial vault reconstruction could be identified. Parameters which could possibly predict the occurrence of complications after surgery were analysed. The endpoint of the study was the explantation of the bone flap resp. the implant due to epidural empyema or aseptic necrosis.

Results: Two hundred nineteen of the identified patients with a mean age of 42.8 (SD 17.89) years could be included in this retrospective study. History of trauma was associated with higher risk for development of aseptic bone flap necrosis. Open/ penetrating traumatic brain injury was statistically associated with a higher complication rate. Fragmented bone flap resulted in a more frequent occurrence of bone flap necrosis. The risk of relevant complications following cranioplasty was higher if a VP shunt was simultaneously placed together with the cranioplasty procedure. Mean duration of cranioplasty was 100.8 minutes (SD 41.2). Duration of cranioplasty procedure was significantly associated with higher postoperative complication rate.

Conclusion: In order to avoid infectious complications after cranial vault reconstruction, indications for VP shunts should be carefully evaluated. The implantation of fragmented bone flaps should be avoided by the use of CAD implants. Patients after open TBI or with alcoholism should be carefully followed up since those patients are prone to develop aseptic necrosis.