Outcomes of Cranioplasty with Synthetic Materials and Autologous Bone Grafts

Piitulainen JM, Kauko T, Aitasalo KMJ, Vuorinen V, Vallittu PK, Posti JP

A retrospective review of the medical records of all patients who underwent cranioplasty for cranial bone defects during the period 2002-2012 was conducted, and 100 consecutive cranioplasty procedures that met eligibility criteria were identified. Patients were analyzed in 4 groups, which were created based on the cranioplasty material: autograft (n=20), bioactive fiber-reinforced composite (n =20), hydroxyapatite (n =31), and other synthetic materials (n =29).

Survival estimates were constructed with Kaplan-Meier curves, and the differences between categorical variable levels were determined using a log-rank test. Multiple comparisons were adjusted using a Sidák correction. During a median follow-up time of 14 months (interquartile range 3e39 months), 32 of 100 patients (32.0%) developed at least 1 complication. A minor complication occurred in 13 patients (13.0%), whereas 19 patients (19.0%) developed a major complication, which required reoperation or removal of the implant. In the autograft subgroup, 40.0% of patients required removal of the cranioplasty.

The 3-year survival of the autograft subgroup was lower compared with other subgroups of synthetic materials. In hydroxyapatite and bioactive fiber-reinforced composite groups, fewer complications were observed compared with the autograft group. Based on these results, synthetic ma- terials for cranial bone defect reconstruction exhibit more promising outcomes compared with autograft. There were differences in survival rates among synthetic materials.

DOI: 10.1016/j.wneu.2015.01.014