Optimal time between decompressive craniectomy and cranioplasty to reduce the risk of complications: A retrospective study

Sep 29, 2026

Uploaded by Noah

Cranioplasty (CP) is carried out after decompressive craniectomy (DC), yet complication rates of 15–40% persist and the risk factors and optimal CP timing remain uncertain. This retrospective single-center study analyzed patients treated at the University Hospital Zurich from 01.2013 to 05.2023 who received CP following a supratentorial DC. Demographics, comorbidities, DC indication, materials, complications, DC–CP interval, and onset were collected. Multivariable logistic regression and CART identified a best cut-off of 122.5 days, suggesting longer intervals may reduce complications.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Abstract

Introduction

Material & methods

Neurosurgical Review (2026) 49:94 [https://doi.org/10.1007/s10143-025-03993-1](https://doi.org/10.1007/s10143-025-03993-1) RESEARCH Optimal time between decompressive craniectomy and cranioplasty to reduce the risk of complications: A retrospective study Federica Stretti1 · Richard Parvin1,9 · Mateo Tomas Fariña Nuñez1,8 · Ignazio De Trizio1 · Massimo Barbagallo1 · Laura Tatsch1 · Johannes Sarnthein2,3 · Giuseppe Esposito2,3 · Clelia Di Serio4,5 · Alberto Pagnamenta5,6,7 · Giovanna Brandi1,3 Received: 29 September 2025 / Revised: 21 November 2025 / Accepted: 25 November 2025 © The Author(s) 2025 Abstract Cranioplasty (CP) is performed after decompressive craniectomy (DC), with complication rates of 15-40% . Risk factors and ideal timing for CP are unclear. This study investigates risk factors for complications after CP and the best time to perform a CP. This retrospective single-center study includes patients admitted to the neurosurgical department of the University Hospital Zurich between 01.2013 and 05.2023, who underwent a CP following a supratentorial DC. Demographics, comorbidities, indication for the DC, material used, complications, time between DC, CP and onset of complication were collected. The investigated complications are infections, bleeding, bone flap resorption or others requiring surgery. A multivariable logistic regression was performed to identify risk factors for the occurrence of complications. A Classification and Regression Tree (CART) was performed to identify the best time for CP. The result was tested with a Cox regression and a ROC analysis. Overall, 141 patients were included, of whom 39%(n=55) developed a complication. No difference in sex, age, comorbidities, DC-indication, material used was found, except for a trend for CP-time (shorter time for patients with vs without complication, 84±44 vs 102±70 days, p=0.065) . In the CART analysis, day 122.5 was the best time cut-off for reducing complications (sensitivity 87%) . In our case-series, we could not identify risk factors for complications after CP, except possibly for CP-timing. A longer time between DC and CP seems to be associated with less complications, with day 122.5 as the cut-off time. Keywords Cranioplasty · Decompressive hemicraniectomy · Intracranial complications · Timing Introduction Decompressive craniectomy (DC) is a life-saving neurosurgical procedure in the management of refractory intracranial hypertension secondary to acute brain injury (ABI), as ischemic stroke, intracranial bleeding or traumatic brain 􀀍 Federica Stretti [federica.stretti@usz.ch](federica.stretti@usz.ch) 1 Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland 2 Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland 3 Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland 4 University Centre for Statistics in the Biomedical Sciences, Vita Salute San Raffaele University, Milan, Italy injury (TBI) [1] . After the acute phase, when the cerebral edema has subsided, cranial reconstruction through cranioplasty (CP) is required [2–6] in order to restore skull integrity for cerebral protection, to reestablish a more physiological cerebral blood flow and cerebral spinal fluid (CSF) dynamics, and also for cosmetic purposes. Despite the 5 Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland 6 Department of Intensive Care, Ente Ospedaliero Cantonale, Lugano, Switzerland 7 Division of Pneumology, University of Geneva, Geneva, Switzerland 8 Department of Orthopaedic Surgery, Neurosurgery and Spine Surgery, Schulthess Clinic, Zurich, Switzerland 9 Neuro-and Spine Center, Lucerne, Switzerland 1 3 relative simplicity of the procedure, CP is associated with high complication rates of 15–40%[7, 8] compared to other elective neurosurgical procedures, and the occurrence of complications can affect the functional outcome [9]. DC perse exposes p

FAQs

What clinical question does the study address?

The study examines risk factors for complications after cranioplasty and determines the best timing to perform cranioplasty following decompressive craniectomy.

How were complications defined and collected?

Complications were infections, bleeding, bone flap resorption, or other issues requiring surgery, with timing between DC and CP and the onset of complication recorded.

What timing cut-off showed the strongest association with fewer complications?

The CART analysis identified day 122.5 as the best cut-off to reduce complications, with 87% sensitivity.

Sep 29, 2026

Uploaded by Noah