Clinical Neurology and Neurosurgery 115 (2013) 1788–1791 Contents lists available at SciVerse ScienceDirect Clinical Neurology and Neurosurgery j o ur nal hom epage: www.elsevier.com/locate/clineuro Complications following cranioplasty using autologous bone or polymethylmethacrylate—Retrospective experience from a single center Lukas Bobinski, Lars-Owe D. Koskinen, Peter Lindvall ∗ Department of Pharmacology and Clinical Neuroscience, Division of Neurosurgery Umeå University, Umeå, Sweden a r t i c l e i n f o Article history: Received 26 August 2012 Received in revised form 7 April 2013 Accepted 20 April 2013 Available online 29 May 2013 Keywords: Decompressive hemicraniectomy Cranioplasty Autologous bone Polymethylmethacrylate Complications a b s t r a c t 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 decom- pressive 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. © 2013 Elsevier B.V. All rights reserved. 1. Introduction The first reported successful cranioplasty was performed in 1668 by the Dutch physician Job Janzoon van Meekren [1]. In modern Neurosurgery there has been an increasing interest in decompressive craniectomies following head trauma and acute ischemic stroke [2–4]. Decompressive craniectomies following head trauma have been shown to reduce the intracranial pres- sure (ICP) in patients with refractory intracranial hypertension, and may also affect the outcome [4–9]. Surviving patients undergoing decompressive craniectomies are obligated to undergo a second procedure with surgical repair of the cranial defect (cranioplasty). Two of the most commonly used materials are autologous bone grafts or polymethylmethacrylate (PMMA). At our institution both these materials have been used for cranioplasty. In our experience ∗ Corresponding author at: Department of Neurosurgery, Umeå University Hos- pital, 901 85 Umeå, Sweden. Tel.: +46 90 785 00 00. E-mail addresses: peter lindvall nkk@hotmail.com, peter.lindvall@neuro.umu.se (P. Lindvall). cranioplasty is a procedure associated with a high rate of compli- cations. This has also been recognized by others, and immediate postoperative complications have been reported to be as high as 34% [10]. Complications may include infection, postoperative haematomas and bone resorption. The timing of surgery in relation to the previous decompressive craniectomy and preferred material to be used for a cranioplasty is still debated [11–13]. Our aim was now to evaluate both short term and long term complications in patients operated with a cranioplasty following a decompressive craniectomy. We also aimed to compare the rate of complications in patients operated using autologous bone vs. PMMA and investigate possible predictors of complications. 2. Materials and methods During a 7-year period (2002–2008) 49 patients were oper- ated with a decompressive craniectomy due to intracranial hypertension following head trauma (closed head injury). These procedures were performed according to our routine with a large frontotemporoparietal craniectomy measuring about 10 × 15 cm. These patients were later on operated with a cranioplasty using 0303-8467/$ – see front matter © 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.clineuro.2013.04.013