Comparison of Complications Following Cranioplasty Using a Sterilized Autologous Bone Flap or Polymethyl Methacrylate

Abstract

Objective: The aims of current study are to compare complications following cranioplasty (CP) using either sterilized autologous bone or polymethyl methacrylate (PMMA), and to identify the risk factors for two of the most common complications: bone flap resorption (BFR) and surgical site infection (SSI).Methods: Between January 2004 and December 2013, 127 patients underwent CP and were followed at least 12 months.Variables, including sex, age, initial diagnosis, time interval between decompressive craniectomy (DC) and CP, operationtime, size of bone flap, and presence of ventriculo-peritoneal shunt, were analyzed to identify the risk factors for BFR andSSI.Results: A total of 97 (76.4%) patients underwent CP using PMMA (Group I) and 30 (23.6%) underwent CP using autologous bone (Group II). SSI occurred in 8 (8.2%) patients in Group I, and in 2 (6.7%) in Group II; there was no statistically signifcant difference between the groups (p=1.00). No statistically signifcant risk factors for SSI were found in either group.In Group I, there was no reported case of BFR. In Group II patients, BFR developed in 18 (60.0%) patients at the time of CP(Type 1 BFR), and at 12-month follow up (Type 2 BFR) in 4 (13.3%) patients. No statistically signifcant risk factors for BFRwere found in Group II.Conclusion: CP using sterilized autologous bone result in a signifcant rate of BFR. PMMA, however, is a safe alloplasticmaterial for CP, as it has low complication rate.