D73. Multidisciplinary Approach to Cranioplasty - Outcomes from a 10-year Retrospective Study

PURPOSE: Cranioplasty to reconstruct large-sized skull defect has a high risk of major complications, including 15- 30% reoperation rate. The objective of this study was to determine whether multidisciplinary surgical approach at a tertiary care institution impacted cranioplasty outcomes. METHODS: We performed a retrospective chart review of patients undergoing cranioplasty from 2011- 2021. Pertinent demographic and surgical data were extracted. Risk factors associated with cranioplasty failure were assessed using chi-square and t-tests. Logistical regression was used to assess odds ratio between number of cranial operations and team involved. RESULTS: A total of 255 patients underwent 301 cranioplasty procedures. Fifty-three patients (20%) had a major complication requiring reoperation, with the most common complications being infection (n = 31, 12%), hematoma (n=11, 4%) and dehiscence (n= 7, 3%). Cases were performed by either a neurosurgeon only (n=248), neurosurgeon plus otolaryngologist (n=23), neurosurgeon plus plastic surgeon (n=30), or all three types of surgeons together (n=1). Plastic surgeons were more likely to be involved in cases with multiple previous cranial operations, including cranioplasty failures (p=0.0205). Interestingly, cases with a plastic surgeon involved (n=30) were associated with fewer complications postoperatively (n=3, 10%, p=0.0302). CONCLUSION: Plastic surgeons are typically consulted after multiple previous cranioplasty failures, despite decreased risk of complications when one is involved. This data further underscores the need for 1) continued efforts to develop neuroplastic surgery multidisciplinary centers for cranioplasty, and 2) a validated, algorithmic approach to predict complications in cranioplasty and risk stratify patients who may benefit from earlier plastic surgery involvement.