Outcome of Cranioplasty, The Factors that Predict Prognosis and Morbidity

Abstract

Background: Raised intracranial pressure (ICP) is a common development from several diseases affecting the cranial vault, especially intracranial mass lesions. Decompressive craniectomy is commonly used to decrease intracranial pressure. In this article we discuss the outcome of reconstruction of skull bone and the factors that predict the prognosis and morbidity. Objective: To determine the outcome of cranioplasty procedures from our experience of single large tertiary care center. Study Design: The type of study is a retrospective cross-sectional review. Settings: Civil Hospital Karachi, Pakistan. Duration: Four years starting from January 2018 to December 2021. Methods: The type of study is a retrospective cross-sectional review, where we took data from four years starting from January 2015 to December 2018. We only included primary autologous cranioplasties, and excluded the non-primary cases, minor cranioplasties, and craniosynostoses related surgeries. Various demographics and clinical parameters were analyzed, including complications, time intervals and other important findings. Results: We included a total of 106 patients in our study population, the mean age was found to be 42.5 ± 16 years, there were n= 65 (61.32%) males and n= 41 (38.67%) were females. Stroke was found to be the most common cause requiring decompression, accounting for 54% of the cases, while trauma was in second place with 35% cases respectively. The mean duration between decompression and cranioplasty was found to be 180 ± 285 days. A total of n= 41 (38.67%) patients of autologous cranioplasty were found to have complications which lead to the removal of the implanted graft in n= 20 (18.86%) of the patients. Patients younger than 30 years of had a significantly increased risk of developing bone flap resorption having a p value of 0.03. A short time interval between decompression and cranioplasty, of between 0 and 3 months and from 3 to 6 months was associated with bone flap resorption having p value of 0.07 and 0.04. We found a significant relationship between smoking and bone flap resorption having a p value of 0.003. Conclusion: Cranioplasty removal was found to be associated with cigarette smoking and younger age of patients <45 years.