Incidence and Risk Factors for Skull Implant Displacement After Cranial Surgery

World Neurosurg. 2019 Jun;126:e814-e818. doi: 10.1016/j.wneu.2019.02.157. Epub 2019 Mar 9.


Objective: Various complications that can occur during and after cranial surgery have been investigated extensively. One of the less frequent complications has thus far received little attention, however: displacement of the skull implant after craniotomy or craniectomy. The purpose of this study is to identify prognostic factors for the development of skull implant displacement (SID).

Methods: In this study, 9087 cranial surgeries performed between 2002 and 2017 were retrospectively examined for the occurrence of SID. Because a first analysis of the investigated data revealed that a notable number of SIDs occurred after a cranioplasty (CP) performed after a decompressive craniectomy (DC), we focused our investigation on these cases. A total of 669 DCs and 329 subsequently performed CPs were analyzed. Several factors were analyzed unadjusted as possible factors influencing the risk for the development of SID.

Results: A total of 13 implant dislocations occurred after CP (3.95%). Fixation technique is the only factor that seems to have had a significant influence, specifically not using miniplates as the fixation technique, which was associated with a higher risk of SID (P = 0.043). However, if fixation techniques are distinguished in more detail, no significant advantage of the miniplates over titanium clamps can be proven (P = 0.123). None of the remaining observed factors showed a statistically provable impact in our data.

Conclusions: A notable number of SIDs only occur after CPs that follow a DC. An advantage in successful placement was observed when fixation of the skull implant during cranioplasty was performed using miniplates.

Keywords: Cranioplasty; Miniplates; Skull implant displacement; Titanium clamps.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Craniotomy / adverse effects*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Prostheses and Implants*
  • Prosthesis Failure / etiology*
  • Retrospective Studies
  • Risk Factors
  • Skull / surgery*
  • Young Adult