Predictive Factors for Outcomes in Alloplastic Cranioplasty: A Review of 101 Cases

Background: Alloplastic cranioplasty is a common procedure in cranial reconstruction, yet factors related to success and failure have been incompletely characterized. Methods: The authors conducted a large-scale retrospective review of patients who underwent alloplastic cranioplasty between 2014 and 2021 at a single institution. Information was collected regarding demographics, wound healing comorbidities, indications for surgery, and outcomes. A multivariable regression analysis was used to determine variables associated with operative complications, implant explantation, and contour defects. Results: One hundred and one patients underwent alloplastic cranioplasty. Fifty-seven percent of patients had at least 1 wound healing comorbidity. The most frequent indications for surgery were trauma (44%), cerebrovascular accident (18%), and cancer (18%). The operative complication rate was 24%. Thirty-six percent of patients had a postoperative contour deformity, and 16% underwent additional surgeries related to cosmesis. At a median follow-up of 1.5 years, 99% of patients maintained either a primary (84%) or secondarily placed (15%) implant. On multivariable analysis, level 4 ASA classification ( P = .05) and heavy alcohol use ( P = .01) were significantly associated with complications. Cerebrovascular accident (CVA) was associated with contour defects ( P = .03). The only factor associated with explantation was heavy alcohol use ( P = .05). Conclusion: This study reviews predictive factors for complications, implant explantation, and poor contour outcomes after alloplastic cranioplasty in a large cohort. Results indicate that alloplastic cranioplasty can have a high success rate with reasonable aesthetic outcomes.