# Effects of cranioplasty with customized 3D titanium mesh plates on postoperative complications and neurological outcomes following traumatic brain injury or stroke: a single-center retrospective study

## TL;DR

This study examines how customized 3D titanium mesh plates used in cranioplasty affect complications and neurological recovery after brain injury or stroke.

## Contribution

The study identifies specific risk factors for complications and poor outcomes following delayed cranioplasty using 3D titanium mesh.

## Key findings

- 45% of patients experienced postoperative complications, with delayed cranioplasty increasing hydrocephalus risk.
- Intraoperative dural depression was linked to higher rates of epidural effusion.
- Bilateral cranioplasty increased wound dehiscence and infection risks.

## Abstract

Persistent controversy surrounds the identification of risk factors contributing to postoperative complications and unfavorable neurological prognoses following cranioplasty (CP) after decompressive craniectomy (DC). This study sought to assess these postoperative outcomes in individuals undergoing 3D titanium mesh CP due to traumatic brain injury (TBI) or hemorrhagic stroke, as well as to determine predictors linked to postoperative complications and suboptimal neurological recovery.

A retrospective, single-center analysis was performed on patients undergoing 3D titanium mesh CP after DC. The primary outcome measure encompassed postoperative complications occurring within 12 months post-CP. The secondary endpoint involved the Glasgow Outcome Scale score assessed at 12 months following CP. We examined various parameters to identify predictors associated with postoperative complications and unfavorable neurological outcomes.

A total of 118 male patients (66%) were included, with trauma accounting for DC in 123 cases (68%). The overall incidence of postoperative complications was 45%, while poor neurological outcomes were observed in 30% of cases. Intraoperative dural depression during CP was correlated with an increased likelihood of postoperative epidural effusion; a time interval exceeding three months between DC and CP was associated with a heightened risk of hydrocephalus; bilateral CP demonstrated an elevated risk of wound dehiscence and infection. For poor GOS outcomes, pre-DC GCS score and DC due to stroke were identified as contributing factors, though no association was found with surgical timing.

Early 3D titanium mesh CP, performed within three months after DC in TBI or stroke patients, appears to be a safe procedure without an increased incidence of postoperative complications or poor neurological prognosis. Conversely, delayed CP exceeding three months post-DC may increase the hydrocephalus’s likelihood. Patients experiencing intraoperative dural depression during CP should be closely monitored for the potential development of postoperative epidural effusion. Additionally, those undergoing bilateral CP are at greater risk for wound dehiscence and infection. Compared to individuals with TBI-induced DC, stroke patients undergoing CP tend to exhibit poorer neurological recovery.