Plastic Surgery Involvement Reduces Cranioplasty Complications

BACKGROUND: Cranioplasty is commonly performed after decompressive craniectomy to provide structural protection of the cerebrum and restore cosmesis. However, procedural complications are not insignificant and can result in prolonged recovery. Although cranioplasties may be performed solely by neurosurgeons, plastic and reconstructive surgeons (PRS) are occasionally consulted for skull reconstruction and wound closure. This study analyzes the impact of PRS involvement in cranioplasty outcomes, including primary and secondary cranioplasty cases. METHODS: A retrospective chart review was conducted examining all cranioplasty procedures performed over 10 years at a single institution. PRS involvement, operative sequence (primary versus secondary), and surgical complications requiring additional clinical follow-up or procedural intervention were noted for each case. RESULTS: Three hundred sixty-four cranioplasty cases were evaluated, with 154 (42.3%) involving PRS. Three hundred four (83.5%) were primary procedures (first reconstruction after craniectomy) and 60 (16.5%) were revisional procedures. PRS involvement had significantly lower rates of extra-axial fluid collection in all cases (OR: 0.42, 95% CI: 0.19-0.86, P=0.022) and in primary procedures (OR: 0.33, CI: 0.13-0.83, P=0.019). Greater impact was found for secondary procedures, where PRS involvement had significantly lower odds of any complication (OR: 0.19, CI: 0.04-0.99, P=0.049), return to operating room (OR: 0.14, CI: 0.03-0.75, P=0.022), and pseudomeningocele (OR: 0.12, CI: 0.02-0.74, P=0.022). CONCLUSIONS: In this single-institution study, PRS involvement was found to significantly improve postoperative outcomes for both primary and secondary cranioplasties, particularly in reducing development of extra-axial fluid collections, pseudomeningocele, and unplanned reoperation. Further investigation with multi-institutional data is warranted.