title: Complications of skull reconstruction after decompressive craniectomy.
abstract: BACKGROUND
  Decompressive craniectomy can be a life-saving procedure. Later reconstruction of the skull using the stored bone flap ("cranioplasty") is often associated with complications. These complications require new procedures and often result in the reconstruction of the skull using an expensive patient-specific cranial implant.
  
  
  METHODS
  All adult patients who underwent cranioplasty after decompressive craniectomy in the last 10 years in our center were included (74 patients). Bone flap size, duration of the procedure, age, and other clinical parameters were included in our analysis.
  
  
  RESULTS
  29.7% of our patients who received in the first place an autologous cranioplasty developed a complication which necessitated removal of the bone flap and the implantation of a custom-made implant. Descriptive statistics demonstrate a significantly higher amount of complications in younger patients (20-40 years, p = 0.027). We also saw a trend toward lower complications when bone flaps were stored according to a biobank protocol (p = 0.075).
  
  
  CONCLUSIONS
  Cranioplasty using the stored bone flap after decompressive craniectomy is associated with a high percentage of complications. Selecting patients at risk could possibly indicate cases where an immediate custom-made implant technique would be required.
authors.affiliation: a Organ Systems , KU Leuven , Leuven , Belgium.
authors.forename: Michiel
authors.initials: M
authors.lastname: Herteleer
authors.affiliation: b Tissue Bank, Universitaire Ziekenhuizen Leuven , Leuven , Belgium.
authors.forename: Nadine
authors.initials: N
authors.lastname: Ectors
authors.affiliation: c Department of Mechanical Engineering, Katholieke Universiteit Leuven Groep Wetenschap and Technologie , Belgium.
authors.forename: Joost
authors.initials: J
authors.lastname: Duflou
authors.affiliation: d Department of Neurosurgery , Universitaire Ziekenhuizen Leuven , Leuven , Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Van Calenbergh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult
keywords: Decompressive craniectomy; complication; cranioplasty; risk factors