title: Outcomes of cranioplasty with synthetic materials and autologous bone grafts.
abstract: OBJECTIVE
  Using current surgical methods, cranioplasty is associated with a high complication rate. We analyzed if there are preexisting medical conditions associated with complications and compared the effect of different implant materials on the degree of complications.
  
  
  METHODS
  A retrospective review of the medical records of all patients who underwent cranioplasty for cranial bone defects during the period 2002-2012 was conducted, and 100 consecutive cranioplasty procedures that met eligibility criteria were identified. Patients were analyzed in 4 groups, which were created based on the cranioplasty material: autograft (n = 20), bioactive fiber-reinforced composite (n = 20), hydroxyapatite (n = 31), and other synthetic materials (n = 29). Survival estimates were constructed with Kaplan-Meier curves, and the differences between categorical variable levels were determined using a log-rank test. Multiple comparisons were adjusted using a Šidák correction.
  
  
  RESULTS
  During a median follow-up time of 14 months (interquartile range 3-39 months), 32 of 100 patients (32.0%) developed at least 1 complication. A minor complication occurred in 13 patients (13.0%), whereas 19 patients (19.0%) developed a major complication, which required reoperation or removal of the implant. In the autograft subgroup, 40.0% of patients required removal of the cranioplasty. The 3-year survival of the autograft subgroup was lower compared with other subgroups of synthetic materials. In hydroxyapatite and bioactive fiber-reinforced composite groups, fewer complications were observed compared with the autograft group.
  
  
  CONCLUSIONS
  Based on these results, synthetic materials for cranial bone defect reconstruction exhibit more promising outcomes compared with autograft. There were differences in survival rates among synthetic materials.
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Division of Surgery and Cancer Diseases, Turku University Hospital, Turku, Finland; Turku Clinical Biomaterials Centre, Institute of Dentistry, University of Turku, Turku, Finland. Electronic address: jaakko.piitulainen@utu.fi.
authors: Jaakko M
authors: JM
authors: Piitulainen
authors: Department of Biostatistics, University of Turku, Turku, Finland.
authors: Tommi
authors: T
authors: Kauko
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Division of Surgery and Cancer Diseases, Turku University Hospital, Turku, Finland; Turku Clinical Biomaterials Centre, Institute of Dentistry, University of Turku, Turku, Finland.
authors: Kalle M J
authors: KM
authors: Aitasalo
authors: Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.
authors: Ville
authors: V
authors: Vuorinen
authors: Turku Clinical Biomaterials Centre, Institute of Dentistry, University of Turku, Turku, Finland.
authors: Pekka K
authors: PK
authors: Vallittu
authors: Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.
authors: Jussi P
authors: JP
authors: Posti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000009:adverse effects; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000379:methods*; D017886:Durapatite; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D064266:Preexisting Condition Coverage; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012886:Skull / Q000002:abnormalities / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D017886:Durapatite
keywords: Autograft; Bioactive glass; Bioglass; Biomaterials; Craniectomy; Cranioplasty; FRC; Fiber-reinforced composite; Skull bone defect