Cranioplasty following ventriculoperitoneal shunting: lessons learned

• DOI: 10.1007/s00701-020-04597-y
• Publication Date: 2020-10-03T05:02:41Z
• Authors: Dorian Hirschmann; Beate Kranawetter; Constanze Kirchsc...; Matthias Tomschik; Jonathan Wais; Fabian Winter; Matthias Millesi; Johannes Herta; Karl Roessler; Christian Dorfer
• Keywords: Cranioplasty; Interventional radiology; Normal pressure hydrocephalus; Neuroradiology; Decompressive craniectomy

Abstract Objective Cranioplasty (CP) is considered as a straightforward and technically unchallenging operation; however, complication rates are high reaching up to 56%. Presence of ventriculoperitoneal shunt (VPS) timing CP reported risk factors for complications. Pressure gradients scarring at the site cranial defect seem be critical in this context. The authors present their experiences lessons learned. Methods A consecutive series all patients who underwent authors’ institution between 2002 2017 were included retrospective analysis. Complications defined events that required reoperation. Logistic regression analysis chi-squared test conducted evaluate according suspected factors. Results total 302 cranioplasty 2017. overall rate was 17.5%. epi-/subdural fluid collection (7.3%) including hemorrhage (4.6%) hygroma (2.6%), bone graft resorption (5.3%), infection (2.0%), hydrocephalus (5.7%). Overall, 57 (18.9%) had undergone implantation prior CP. incidence 19.3% with VPS 4.5% without VPS, OR 5.1 (95% CI 2.1–12.4). Incidence higher early Patients temporary ligation did not suffer from Conclusion remains high-risk procedure. Any effort understand pressure dynamics reduce may trigger formation large epidural space must undertaken.