title: A retrospective analysis and review of an institution's experience with the complications of cranioplasty.
abstract: BACKGROUND
  Cranial reconstruction with a cranioplasty is performed to repair skull defects after decompressive craniectomies.
  
  
  OBJECTIVE
  To retrospectively review all cranioplasties performed in our institution over 10 years and analyse the complications and the factors that cause complications.
  
  
  METHODS
  Two hundred and forty-three cranioplasties were performed from 2000 to 2010, with a follow-up of at least 1 year. Age, sex, comorbidities, material, site of skull defect, time between decompression and cranioplasty, and rate of complications were collected from our database. Fischer's T-test and direct logistical regression were performed to identify factors that contributed to the rate of complications. p < 0.05 was considered significant.
  
  
  RESULTS
  Post-cranioplasty seizures (14.81%), infection and exposed implant (9.05%), haemorrhage (1.65%) and others (0.82%) were identified complications. Total percentage of complications was 25.92%. Previous trauma (p = 0.034) and intracranial haemorrhage (p = 0.019) as well as pre-cranioplasty neurological deficit (p = 0.046) were related to seizures, while pre-cranioplasty neurological deficit (p = 0.036) and exposed implant extrusion (p = 0.048) contributed to infection of cranioplasties.
  
  
  CONCLUSIONS
  Most of the seizures may be post-traumatic seizures or scar epilepsy from intracranial haemorrhage. Implant extrusions were found to be associated with infection of the implant, and they should therefore be treated early. Patient selection is important as patients with neurological deficits were susceptible to seizures and infection. Intracranial haemorrhage was caused by persistant bleeding, trauma or shunt overdrainge.
  
  
  CONCLUSIONS
  Cranioplasty has significant complications. A thorough understanding of factors that contribute to the different types of complications will benefit the management of cranioplasty patients.
authors.affiliation: Department of Neurosurgery, National University Hospital, Singapore. zhihaosg@hotmail.com
authors.forename: Lester
authors.initials: L
authors.lastname: Lee
authors.forename: Justin
authors.initials: J
authors.lastname: Ker
authors.forename: Boon Leong
authors.initials: BL
authors.lastname: Quah
authors.forename: Ning
authors.initials: N
authors.lastname: Chou
authors.forename: David
authors.initials: D
authors.lastname: Choy
authors.forename: Tseng Tsai
authors.initials: TT
authors.lastname: Yeo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D020300:Intracranial Hemorrhages / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D012886:Skull / Q000601:surgery*; D055815:Young Adult