Introduction: Craniectomy is occasionally required in neurosurgical practice, not just as a decompressive tool following cerebral infarction or traumatic brain injury, but also when managing deep seated post operative infection, or the removal of osseous tumours. There are a number of reconstructive options available to the surgeon, but a common complication to all is infection. We undertook a retrospective review of our practice to better quantify the risks of all complications.
Methods: Retrospective chart analysis of all patients undergoing cranioplasty from 2006-2015 at our institution.
Results: 177 patients underwent a cranioplasty. The underlying aetiologies were predominantly following decompressive craniectomy for trauma (84), for stroke – either embolic/thrombotic/ICH (24), or for infection -primary or post craniotomy (37). The vast majority (155/177) utilised a custom-made titanium plate. 19 patients acquired a post-operative infection of the cranioplasty, 16 requiring removal of the cranioplasty. 8 of these patients were able to undergo successful reinsertion of an implant during the follow up period. 2 patients suffered repeat infections. 9 patients developed symptomatic collections of blood/air under the plate, 4 of whom required an urgent return to theatre to evacuate conservatively. Three requested revision surgery due to discomfort, prominent mesh, and poor cosmesis respectively. Two requested intervention for temporalis muscle bunching – either revision or botox, and three patients developed hydrocephalus following cranioplasty requiring shunting. There was no mortality.
Conclusions: Our patients currently experience a 10.7% risk of infection following cranioplasty, which is in keeping with published data. There was no statistically significant difference in infection risks between cranioplasty material, underlying aetiology, previous radiotherapy or comorbidities in this data group. There are numerous other associated complications that may require surgical intervention. Larger data sets, such as a national registry, will help better delineate the associated risk factors for complications.
Patient Care: Better information regarding risks is always useful when counselling patients - this also serves as a prudent and timely reminder that there are other complications that occur beyond infection that need consideration.
Learning Objectives: By the conclusion of this session, participants should be well informed as to the potential risks of a cranioplasty following an audit of a decades practice in a major trauma centre and busy neurosurgical service