Cranioplasty is a well-accepted neurosurgical procedure that has application to a wide range of pathologies. Given the varied need for both autologous and synthetic cranial grafts, it is important to establish rates of procedural complication.

      A retrospective review identified 282 patients undergoing cranioplasty at our institution over a ten-year period, of which 249 patients underwent 258 cranioplasties with either autologous or acrylic flaps.

     249 patients underwent 258 cranioplasties with either autologous or acrylic flaps.

     A database including patient age, gender, presenting diagnosis, hospital of surgery, presence of a drain and surgical complications was created in order to analyze the autologous and acrylic cranioplasty data. A total of 28 complications were noted, yielding a rate of 10.9% (28/258). There was no statistically significant difference in infection rate between autologous and acrylic cranioplasty (7.2% v. 5.8%, p=0.42).

     Male patients (p=0.004), tumor patients (p=0.01) and patients undergoing surgery at the county hospital (p=0.04) sustained a statistically higher rate of infection. Amongst traumatic brain injury (TBI) patients, complex injuries and surgical involvement of the frontal sinus carried a significantly higher infection rate of 17% and 38.5%, respectively (p=0.02, p=0.001). Post-operative epidural hematoma requiring re-operation occurred in 3.5% (9/258) with no difference in hematoma rate with placement of a drain (p=0.51).

     This is a retrospective study.

     Cranioplasty carries a significant risk of infection and post-operative hematoma.

     In this large series comparing autologous and acrylic flaps, male patients, tumor patients and those undergoing surgery at the county hospital were at increased risk of post-operative infection. Amongst TBI cases, complex injuries and cases with surgical involvement of the frontal sinus may portend a higher risk.