# German cranial reconstruction registry – a prospective multicenter cohort study: 883-day follow-up on the outcome and complications

## TL;DR

This study tracks long-term outcomes and complications of cranioplasty surgery in 200 patients, finding a 25% surgical revision rate and factors that predict better or worse outcomes.

## Contribution

The study provides new insights into predictors of surgical revision and favorable neurological outcomes following cranioplasty.

## Key findings

- The surgical revision rate after cranioplasty was 25%.
- Suction drains were associated with a lower long-term surgical revision rate.
- Simultaneous ventriculoperitoneal shunt placement increased the likelihood of surgical revision.

## Abstract

This international prospective multicenter cohort study investigates the long-term surgical complication rate and neurological outcomes in patients who underwent autologous or allogeneic cranioplasty (CP) after decompressive craniectomy (DC) for traumatic brain injury, stroke, aneurysmatic subarachnoid hemorrhage, and intracranial hemorrhage.

This study investigated the predictors of long-term outcomes and surgical revision after cranioplasty.

Patients who underwent CP with a minimum follow-up of at least 12 months were included. Favorable long-term outcome (FLTO) was defined as a Glasgow Outcome Score (GOS) of 4 or 5 and a modified Rankin scale (mRS) score of <4. Univariate and multivariate analyses were performed.

A total of 200 patients with a median follow-up of 883.1 ± 520.5 days were included. Ninety-nine patients (50.0 %) had a FLTO, and the surgical revision rate was 25.0 % (n = 50). Thirty-eight percent (37.7 %) and 27.5 % of patients showed improvement in the mRS and GOS scores, respectively. Simultaneous implantation of a ventriculoperitoneal shunt (OR 6.114) and a time interval of <90 days between DC and CP (OR 2.189) predicted an increase in reoperation rates. The use of subcutaneous drains with suction predicted a lower rate of reoperation (OR .410). Diabetes mellitus (OR .221) and reoperations during the initial stay (OR .347) were negative predictors of FLTO. Implants imbued with antibiotics predicted a positive FLTO (OR 2.973).

Suction drains were predicted to reduce reoperation rates. Simultaneous implantation of VPS and CP within 3 months of DC predicted an increased likelihood of surgical revision.

•The surgical revision rate after cranioplasty was 25 %.•After cranioplasty, 37.7 % of patients showed improved neurological status.•Suction drains were associated with a lower long-term surgical revision rate.•Simultaneous ventriculoperitoneal shunt placement was associated with a higher long-term surgical revision rate.•Cranioplasty within 90 days of decompressive craniectomy was associated with an increased surgical revision rate.

The surgical revision rate after cranioplasty was 25 %.

After cranioplasty, 37.7 % of patients showed improved neurological status.

Suction drains were associated with a lower long-term surgical revision rate.

Simultaneous ventriculoperitoneal shunt placement was associated with a higher long-term surgical revision rate.

Cranioplasty within 90 days of decompressive craniectomy was associated with an increased surgical revision rate.