title: Complications following cranioplasty using autologous bone or polymethylmethacrylate--retrospective experience from a single center.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Division of Neurosurgery Umeå University, Umeå, Sweden.
authors.forename: Lukas
authors.initials: L
authors.lastname: Bobinski
authors.forename: Lars-Owe D
authors.initials: LO
authors.lastname: Koskinen
authors.forename: Peter
authors.initials: P
authors.lastname: Lindvall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001843:Bone Cements; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D016489:Head Injuries, Closed / Q000150:complications / Q000601:surgery; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: Autologous bone; Complications; Cranioplasty; Decompressive hemicraniectomy; Polymethylmethacrylate