Acta Neurochirurgica

, Volume 161, Issue 1, pp 25–31 | Cite as

Defining “early” cranioplasty to achieve lower complication rates of bone flap failure: resorption and infection

  • Jang Hun Kim
  • Soon-Young Hwang
  • Taek-Hyun Kwon
  • Kyuha Chong
  • Won-Ki Yoon
  • Jong Hyun KimEmail author
Original Article - Neurosurgery general
Part of the following topical collections:
  1. Neurosurgery general



Although cranioplasty (CP) is a frequently performed and simple procedure, complications are common, particularly bone flap resorption and infection. The timing of surgery is as an important contributory factor, but the optimal timing has not been clearly determined.


We retrospectively investigated bone flap resorption and surgical site infection after CP to determine the optimal timing of surgery for reduction of complications.


The study enrolled 126 patients who underwent decompressive craniectomy (DC) and subsequent CP. Patients with bone flap resorption or surgical site infection were analyzed as the “complication” group. Receiver operating characteristic curve analysis was performed and the Youden index was used to dichotomize “early CP” and “late CP” groups. Univariate and multivariate survival analyses were performed.


The complication group included 42 patients. The Youden index was used to identify a cutoff value for the DC-CP interval of > 44 days, and this was used to define early (< 45 days) and late (≥ 45 days) CP. Late CP was a significant risk factor in univariate and multivariate Cox regression analyses.


This study showed that early CP before 45 days after DC is associated with a lower rate of bone flap resorption and surgical site infection than late CP.


Bone flap resorption Cranioplasty Early cranioplasty Surgical site infection Optimal timing 



This was supported by Korea University Grant.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee [2017GR0098] and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Jang Hun Kim
    • 1
    • 2
  • Soon-Young Hwang
    • 3
  • Taek-Hyun Kwon
    • 1
  • Kyuha Chong
    • 1
  • Won-Ki Yoon
    • 1
  • Jong Hyun Kim
    • 1
    Email author
  1. 1.Department of NeurosurgeryKorea University Guro Hospital, Korea University College of MedicineSeoulRepublic of Korea
  2. 2.Focused Training Center for Trauma, Korea University Guro HospitalKorea University College of MedicineSeoulRepublic of Korea
  3. 3.Biostatistical consulting lab, Medical Science Research CenterKorea University College of MedicineSeoulRepublic of Korea

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