Predictors of cranioplasty complications in stroke and trauma patients

Clinical article

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Decompressive craniectomy mandates subsequent cranioplasty. Complications of cranioplasty may be independent of the initial craniectomy, or they may be contingent upon the craniectomy. Authors of this study aimed to identify surgery- and patient-specific risk factors related to the development of surgical site infection and other complications following cranioplasty.


A consecutive cohort of patients of all ages and both sexes who had undergone cranioplasty following craniectomy for stroke or trauma at a single institution in the period from May 2004 to May 2012 was retrospectively established. Patients who had undergone craniectomy for infectious lesions or neoplasia were excluded. A logistic regression analysis was performed to model and predict determinants related to infection following cranioplasty.


Two hundred thirty-nine patients met the study criteria. The overall rate of complication following cranioplasty was 23.85% (57 patients). Complications included, predominantly, surgical site infection, hydrocephalus, and new-onset seizures. Logistic regression analysis identified previous reoperation (OR 3.25, 95% CI 1.30–8.11, p = 0.01) and therapeutic indication for stroke (OR 2.45, 95% CI 1.11–5.39, p = 0.03) as significantly associated with the development of cranioplasty infection. Patient age, location of cranioplasty, presence of an intracranial device, bone flap preservation method, cranioplasty material, booking method, and time interval > 90 days between initial craniectomy and cranioplasty were not predictive of the development of cranioplasty infection.


Cranioplasty complications are common. Cranioplasty infection rates are predicted by reoperation following craniectomy and therapeutic indication (stroke). These variables may be associated with patient-centered risk factors that increase cranioplasty infection risk.

Article Information

Address correspondence to: Brian P. Walcott, M.D., Massachusetts General Hospital, 55 Fruit Street, White Building Room 502, Boston, Massachusetts 02114. email:

Please include this information when citing this paper: published online February 8, 2013; DOI: 10.3171/2013.1.JNS121626.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Bar graph showing that surgical indication predicts cranioplasty infection. In logistic regression analysis, the indication for craniectomy (stroke) predicted subsequent cranioplasty infection (OR 2.45, 95% CI 1.11–5.39, p = 0.03). n = number of cases; # = number.

  • View in gallery

    Bar graph indicating that the bone flap storage method does not predict cranioplasty infection (frozen storage: OR 1.95, 95% CI 0.64–5.95, p = 0.24; subcutaneous storage: OR 1.82, 95% CI 0.71–4.68, p = 0.22).

  • View in gallery

    Bar graph indicating that the type of cranioplasty material used does not predict cranioplasty infection (OR 1.78, 95% CI 0.73–4.37, p = 0.21).



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