Introduction: An understanding of the high risk nature of cranioplasty is limited by under-reporting of treatment paradigms. The preoperative decision making, material choice, surgical techniques, and postoperative care is highly variable and often not considered in the analysis of complications. We aimed to describe a treatment paradigm in patient selection, work-up, operative technique, and postoperative care designed to minimize complications.

Methods: A retrospective review of all patients at a single institution who underwent cranioplasty guided by a paradigm designed to reduce complications between December 2007 until September 2016 was performed. Patient demographics, preoperative evaluation and decision making, operative considerations and postoperative care were recorded. A retrospective review was used to confirm adherence to the paradigms and deviations were recorded. Complications evaluated induced reoperation for hematoma, post cranioplasty hydrocephalus, seizures, infections, and long term failure. Similar data from large, modern reports were analyzed to compare outcomes.

Results: 148 patients met the study criteria. The overall complication rate was 3.6%. No patients developed postoperative hematoma requiring evacuation, 6 patients developed superficial wound dehiscence or infection of which 2 required reoperation. The average length of stay was 4.2 day overall, including 2.2 days in the ICU. Two patients were discharged to higher levels of care from admission and 146 were discharged to similar to lower levels of care. The average follow up was 4.59 years. Analysis from pooled results of comparative modern series demonstrates higher incidence of overall complications, re-operation, infection, hematoma and seizures as compared to this series.

Conclusions: We describe a treatment paradigm for cranioplasty and report results in 148 consecutive patients with lower incidence of all complications as compared to prior reports. The paradigm is described in detail and provides a frame work for treatment of patients who require cranioplasty and highlights the need for further analysis to reduce complications.

Patient Care: Helping to reduce complications in cranioplasty

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of complication avoidance and management in cranioplasty surgery. 2) Discuss, in small groups common complications in cranioplasty and their management. 3) Identify an effective treatment and prevention for complications in cranioplasty

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