Isabel Snee, Ryan Gensler, Ehsan Dowlati, Rajiv P. Parikh, Daniel Felbaum
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引用次数: 0
Abstract
Background
Cranioplasty is performed to restore cranial integrity following decompressive hemicraniectomy, with both autologous bone grafts (ABGs) and synthetic grafts (SGs) serving as reconstructive options. While previous studies have examined clinical outcomes, there is a lack of robust data comparing aesthetic outcomes and complication rates between ABGs and SGs. This study evaluates these parameters to guide optimal graft selection.
Method
A single-center retrospective review was conducted on patients who underwent cranioplasty with either ABGs or SGs between January 2017 and November 2023. Patient demographics, perioperative variables, and postoperative complications were collected. Aesthetic outcomes were assessed using axial CT scans to measure frontal and parietal asymmetry. Statistical analyses included univariate and multivariate comparisons, adjusting for potential confounders such as age, cerebrovascular accident (CVA) history, hypertension (HTN), atrial fibrillation (AFib), ventriculoperitoneal (VP) shunt status, and insurance type.
Results
Among 200 patients, 82 (41.0%) received ABGs, and 118 (59.0%) received SGs. Frontal and parietal asymmetry scores did not significantly differ between groups (p = 0.321, p = 0.348). Median time to cranioplasty was shorter for ABGs than SGs (106.5 vs. 117 days; p = 0.038). Postoperative complications were significantly higher in the SG group compared to ABGs (30.5% vs. 9.8%; p = 0.001), with infections being more frequent in SGs (p = 0.048). SGs were also associated with a higher rate of revision surgeries.
Conclusions
ABGs and SGs provide comparable aesthetic outcomes, but SGs carry a significantly higher risk of complications and revisions. Given its lower complication rates and cost-effectiveness, ABGs should be prioritized when feasible. However, SGs remain a viable option in cases where autologous bone is unavailable or contraindicated. Future studies should focus on long-term follow-up and patient-reported outcomes to further refine cranioplasty decision-making.
期刊介绍：
The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.
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