Balancing form and function: A single-center review of autologous vs. synthetic grafts in cranioplasty

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2025-03-04 DOI:10.1007/s00701-025-06480-0

Isabel Snee, Ryan Gensler, Ehsan Dowlati, Rajiv P. Parikh, Daniel Felbaum

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引用次数: 0

Abstract

Background

Cranioplasty is performed to restore cranial integrity following decompressive hemicraniectomy, with both autologous bone grafts (ABGs) and synthetic grafts (SGs) serving as reconstructive options. While previous studies have examined clinical outcomes, there is a lack of robust data comparing aesthetic outcomes and complication rates between ABGs and SGs. This study evaluates these parameters to guide optimal graft selection.

Method

A single-center retrospective review was conducted on patients who underwent cranioplasty with either ABGs or SGs between January 2017 and November 2023. Patient demographics, perioperative variables, and postoperative complications were collected. Aesthetic outcomes were assessed using axial CT scans to measure frontal and parietal asymmetry. Statistical analyses included univariate and multivariate comparisons, adjusting for potential confounders such as age, cerebrovascular accident (CVA) history, hypertension (HTN), atrial fibrillation (AFib), ventriculoperitoneal (VP) shunt status, and insurance type.

Results

Among 200 patients, 82 (41.0%) received ABGs, and 118 (59.0%) received SGs. Frontal and parietal asymmetry scores did not significantly differ between groups (p = 0.321, p = 0.348). Median time to cranioplasty was shorter for ABGs than SGs (106.5 vs. 117 days; p = 0.038). Postoperative complications were significantly higher in the SG group compared to ABGs (30.5% vs. 9.8%; p = 0.001), with infections being more frequent in SGs (p = 0.048). SGs were also associated with a higher rate of revision surgeries.

Conclusions

ABGs and SGs provide comparable aesthetic outcomes, but SGs carry a significantly higher risk of complications and revisions. Given its lower complication rates and cost-effectiveness, ABGs should be prioritized when feasible. However, SGs remain a viable option in cases where autologous bone is unavailable or contraindicated. Future studies should focus on long-term follow-up and patient-reported outcomes to further refine cranioplasty decision-making.

查看原文本刊更多论文

平衡形式和功能：自体与合成骨瓣在颅骨成形术中的单中心回顾

背景：在半颅骨减压切除术后进行颅骨成形术以恢复颅骨完整性，自体骨移植物（ABGs）和合成骨移植物（SGs）均可作为重建选择。虽然以前的研究已经检查了临床结果，但缺乏比较ABGs和SGs之间美学结果和并发症发生率的可靠数据。本研究评估这些参数以指导最佳移植物选择。方法对2017年1月至2023年11月期间接受ABGs或SGs颅骨成形术的患者进行单中心回顾性分析。收集患者人口统计资料、围手术期变量和术后并发症。通过轴向CT扫描测量额叶和顶叶不对称来评估美学结果。统计分析包括单因素和多因素比较，调整潜在混杂因素，如年龄、脑血管事故（CVA）史、高血压（HTN）、心房颤动（AFib）、脑室-腹膜（VP）分流状态和保险类型。结果200例患者中有82例（41.0%）接受了ABGs检查，118例（59.0%）接受了SGs检查。额、顶叶不对称评分组间差异无统计学意义（p = 0.321, p = 0.348）。ABGs患者到颅骨成形术的中位时间短于SGs患者(106.5天vs 117天；p = 0.038)。SG组术后并发症明显高于ABGs组(30.5% vs 9.8%；p = 0.001)， SGs感染更为常见（p = 0.048）。SGs也与更高的翻修手术率相关。结论：sabg和SGs的美学效果相当，但SGs的并发症和修复风险明显更高。鉴于其较低的并发症发生率和成本效益，在可行的情况下应优先考虑ABGs。然而，在自体骨不可用或有禁忌的情况下，SGs仍然是一个可行的选择。未来的研究应侧重于长期随访和患者报告的结果，以进一步完善颅骨成形术的决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.