Page 42 - Clinical relevance of current materials for cranial implants
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Chapter 2
Resorption rates were reported in 117 studies. Resorption occurred mostly in autologous grafts, where it was reported in 42 studies and ranged from 0 to 100% with an overall resorption rate of 11.3%.
Cranioplasty removal rate was stated in 194 studies. The lowest graft removal rate was reported for HA (overall: 2.5%). The greatest removal rate was reported for autologous cranioplasties (overall: 10.4%). This was significantly greater than that of the combined alloplastic materials (overall: 5.1%; RD = 0.052 [95% CI 0.039-0.066]; NNT = 19 (95% CI 15-25); RR = 0.50 [95% CI 0.42-0.58]). Overall, removal was required in 6.6% of the cranioplasties in all studies reporting removals.
Other complications
Complications after cranioplasty were reported in 220 studies, with a total complication rate of 18.9%. Hematoma (1.9%), cerebrospinal fluid leak (1.4%), and wound dehiscence (1.1%) occurred most frequently after infection (5.6%) and bone resorption (5.2%) (Table 4).
Autologous bone showed the highest complication rate at 35.7%. HA showed the lowest complication rate at 10.5%. The greatest complication rate was reported by Lee et al.,59 with 135%, as there were multiple complications (total n = 19) per patient after 14 cranioplasties, although it was unclear how these complications were distributed amongst the patients. The lowest complication rate was reported by Liu et al.,60who stated that all 598 patients did not show any complications following 611 cranioplasties. Timing of complications after cranioplasty was reported in 72 studies, ranging from immediately61 to 9 years62 after decompressive craniectomy.
Treatment policy after complications
Of the 220 studies reporting complications, 122 mentioned a treatment plan. Removal of the cranioplasty was reported in 6.6% of cases, followed by 2.2% surgeries, and 1.6% cases of expectative policy. Other policies, including antibiotic treatment and wound debridement, were performed in 0.5% of cases (Table 4).


























































































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