Open Traumatic Brain Injury Is a Strong Predictor for Aseptic Bone Necrosis after Cranioplasty Surgery: A Retrospective Analysis of 219 Patients.

Objective To investigate whether independent predictors of complications after cranioplasty are identifiable. Methods Parameters that could predict the occurrence of complications were analyzed retrospectively. The end point of the study was the explantation of the bone flap. Results A total of 219 patients with a mean age of 42.8 years (standard deviation: 17.89) were included. History of trauma and especially open traumatic brain injury (TBI) were associated with a higher complication rate (p = 0.01 and p = 0.02, respectively). Multivariate testing showed that fragmented bone flap resulted in a more frequent occurrence of bone flap necrosis (p = 0.014). The risk of complications following cranioplasty was higher if a ventriculoperitoneal (VP) shunt was placed at the same time (p = 0.01). Longer duration of the cranioplasty procedure was significantly associated with a higher postoperative complication rate (p = 0.001). Subsequent rehabilitation is more frequent if patients develop a complication. Conclusions To avoid complications after cranial vault reconstruction, indications for simultaneous VP shunt implantation should be carefully evaluated. The implantation of traumatically fragmented bone flaps should be avoided. Patients after open TBI should either primarily be treated with an allogenic graft or they should be carefully followed up because they are prone to develop aseptic necrosis.