Risk of Complications in Primary Versus Revision-Type Cranioplasty

Tamir Shay, Micah Belzberg, Anthony O. Asemota, Kerry Ann Mitchell, Amir Wolff, Gabriel F. Santiago, Judy Huang, Henry Brem, Chad R. Gordon

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Introduction:Cranioplasty (CP) is a multifaceted procedure in a heterogenous patient population, with a high risk for complication. However, no previous large-scale studies have compared outcomes in primary (ie, first attempt) CP versus revision CP (ie, following previous attempts). The authors, therefore, analyzed long-term outcomes of 506 consecutive primary and revision CPs, performed by a single surgeon.Methods:All CPs performed between 2012 and 2019 were analyzed under IRB protocol approval. Surgeries were categorized as either primary (no previous CP; n=279) or revision CP (at least one previous CP; n=227). Complications were defined as either major or minor. Subgroup analyses investigated whether or not CP complication risk directly correlated with the number of previous neuro-cranial surgeries and/or CP attempts.Results:The primary CP group experienced a major complication rate of 9% (26/279). In comparison, the revision CP group demonstrated a major complication rate of 32% (73/227). For the revision CP group, the rate of major complications rose with each additional surgery, from 4% (1 prior surgery) to 17% (2 prior surgeries) to 39% (3-4 prior surgeries) to 47% (≥5 prior surgeries).Conclusion:In a review of 506 consecutive cases, patients undergoing revision CP had a 3-fold increase in incidence of major complications, as compared to those undergoing primary CP. These results provide critical insight into overall CP risk stratification and may guide preoperative risk-benefit discussions. Furthermore, these findings may support a center-of-excellence care model, particularly for those patients with a history of previous neuro-cranial surgeries and/or CP attempts.

Original languageEnglish (US)
Pages (from-to)423-427
Number of pages5
JournalJournal of Craniofacial Surgery
Issue number2
StatePublished - 2020


  • Alloplastic
  • autologous
  • complication
  • cranial reconstruction
  • cranioplasty
  • implant
  • revision
  • risk factor
  • skull
  • synthetic

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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