title: Open Traumatic Brain Injury Is a Strong Predictor for Aseptic Bone Necrosis after Cranioplasty Surgery: A Retrospective Analysis of 219 Patients.
abstract: OBJECTIVE
  To investigate whether independent predictors of complications after cranioplasty are identifiable.
  
  
  METHODS
  Parameters that could predict the occurrence of complications were analyzed retrospectively. The end point of the study was the explantation of the bone flap.
  
  
  RESULTS
  A total of 219 patients with a mean age of 42.8 years (standard deviation: 17.89) were included. History of trauma and especially open traumatic brain injury (TBI) were associated with a higher complication rate (p = 0.01 and p = 0.02, respectively). Multivariate testing showed that fragmented bone flap resulted in a more frequent occurrence of bone flap necrosis (p = 0.014). The risk of complications following cranioplasty was higher if a ventriculoperitoneal (VP) shunt was placed at the same time (p = 0.01). Longer duration of the cranioplasty procedure was significantly associated with a higher postoperative complication rate (p = 0.001). Subsequent rehabilitation is more frequent if patients develop a complication.
  
  
  CONCLUSIONS
  To avoid complications after cranial vault reconstruction, indications for simultaneous VP shunt implantation should be carefully evaluated. The implantation of traumatically fragmented bone flaps should be avoided. Patients after open TBI should either primarily be treated with an allogenic graft or they should be carefully followed up because they are prone to develop aseptic necrosis.
authors.affiliation: Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: von der Brelie
authors.affiliation: Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Igor
authors.initials: I
authors.lastname: Stojanovski
authors.affiliation: Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Ullrich
authors.initials: U
authors.lastname: Meier
authors.affiliation: Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Lemcke
mesh_terms: D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D001842:Bone and Bones / Q000473:pathology*; D001930:Brain Injuries / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005597:Fractures, Open / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010020:Osteonecrosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects