A1 Refereed original research article in a scientific journal
Predictors of primary autograft cranioplasty survival and resorption after craniectomy
Authors: Tommi K. Korhonen, Sami Tetri, Jukka Huttunen, Antti Lindgren, Jaakko M. Piitulainen, Willy Serlo, Pekka K. Vallittu, Jussi P. Posti; on behalf of the Finnish National Cranial Implant Registry (FiNCIR) study group
Publisher: AMER ASSOC NEUROLOGICAL SURGEONS
Publication year: 2019
Journal: Journal of Neurosurgery
Journal name in source: JOURNAL OF NEUROSURGERY
Journal acronym: J NEUROSURG
Volume: 130
Issue: 5
First page : 1672
Last page: 1679
Number of pages: 1
ISSN: 0022-3085
DOI: https://doi.org/10.3171/2017.12.JNS172013
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/31088907
OBJECTIVE
Craniectomy 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.
METHODS
The 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.
RESULTS
The 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.
CONCLUSIONS
In 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.
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