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Complications following cranioplasty using autologous bone or polymethylmethacrylate-Retrospective experience from a single center
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
2013 (English)In: Clinical neurology and neurosurgery (Dutch-Flemish ed. Print), ISSN 0303-8467, E-ISSN 1872-6968, Vol. 115, no 9, 1788-1791 p.Article in journal (Refereed) Published
Abstract [en]

Objective: A decompressive hemicraniectomy is a potentially life-saving intervention following head trauma. Once performed patients are obliged to undergo a second procedure with cranioplasty. Two of the most commonly used materials are autologous bone and polymethylmethacrylate (PMMA). We have now evaluated complications following a cranioplasty using these materials. Materials and methods: During a 7-year period (2002-2008) 49 patients were operated with a decompressive craniectomy following head trauma. Patients received a cranioplasty consisting of autologous bone (30 patients, 61.2%) or PMMA (19 patients, 38.8%) and were followed at least 24 months. Patient data were collected retrospectively. Results: Twenty patients (20/49, 40.8%) experienced a complication that prompted a re-operation. There was a significantly higher rate of complications leading to a re-operation (53.3% vs. 21.1%, p = 0.03) and a shorter survival time of the cranioplasty (mean 48.1 +/- 7.8 vs. 79.5 +/- 9.0 months, p = 0.035) in patients with autologous bone compared to PMMA. Bone resorption and the presence of postoperative hematomas were significantly more common in patients with autologous bone. The material used for cranioplasty was the only variable that significantly correlated to the rate of complications. Conclusions: In our series we had a high percentage of patients needing re-operation due to complications following a cranioplasty. Though generally considered a straightforward procedure, complications and associated morbidity in patients undergoing cranioplasty should not be underestimated. 

Place, publisher, year, edition, pages
2013. Vol. 115, no 9, 1788-1791 p.
Keyword [en]
Decompressive hemicraniectomy, Cranioplasty, Autologous bone, Polymethylmethacrylate, Complications
National Category
URN: urn:nbn:se:umu:diva-82299DOI: 10.1016/j.clineuro.2013.04.013ISI: 000324787900039OAI: diva2:668765
Available from: 2013-12-02 Created: 2013-10-29 Last updated: 2016-07-13Bibliographically approved
In thesis
1. On evolution of intracranial changes after severe traumatic brain injury and its impact on clinical outcome
Open this publication in new window or tab >>On evolution of intracranial changes after severe traumatic brain injury and its impact on clinical outcome
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Severe traumatic brain injury (sTBI) is a cause of death and disability worldwide and requires treatment at specialized neuro-intensive care units (NICU) with a multimodal monitoring approach. The CT scan imaging supports the monitoring and diagnostics. The level of S100B and neuron specific enolase (NSE) reflects the severity of the injury. The therapy resistant intracranial hypertension requires decompressive craniectomy (DC). After DC, the cranium must be reconstructed to recreate the normal intracranial physiology as well as to address cosmetic issues. The evolution of the pathological intracranial changes was analyzed in accordance with the three CT classifications: Marshall, Rotterdam and Morris-Marshall. The Rotterdam scale was best in describing the dynamics of the pathological evolution. Both the Rotterdam score and Morris- Marshall classification showed strong correlation with the clinical outcome, a finding that suggests that they could be used for prognostication. We demonstrated a clear correlation between the CT classifications and concentrations of S100B and NSE. The results revealed a concomitant correlation between NSE and S100B and clinical outcome. We found that the interaction between the ICP, Rotterdam CT classification, and concentrations of biochemical biomarkers are all associated with DC. We found a high percentage of complications following cranioplasty. Our results call into question whether custom-made allograft should be considered the best material for cranioplasty. It is concluded that both the Rotterdam and Morris-Marshall classification contribute to clinical evaluation of intracranial dynamics after sTBI, and might be used in combination with biochemical biomarkers for better assessment. The decision to perform DC should include a re-assesment of ICP evolution, CT scan images and concentration of the biochemical biomarkers. Furthermore, when determining whether DC treatment should be used, surgeon should also consider the risks of the following cranioplasty.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 134 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1836
Severe traumatic brain injury, ICP targeted therapy, ICP, decompressive craniectomy, S100B, NSE, cranioplasty
National Category
Other Medical Sciences Neurology
Research subject
urn:nbn:se:umu:diva-124069 (URN)978-91-7601-442-4 (ISBN)
Public defence
2016-09-02, Sal E04, byggnad 6A, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Available from: 2016-08-18 Created: 2016-07-11 Last updated: 2016-10-14Bibliographically approved

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Bobinski, LukasKoskinen, Lars-Owe D.Lindvall, Peter
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