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Advanced Neurology Outcomes of implant usage for depressed skull fractures

3. Results polyetheretherketone (PEEK), and 1% PMMA. After
dichotomization, 82% utilized autologous implant material
3.1. Selection of sources of evidence
and 18% non-autologous implants. In the autologous
Figure 1 shows the study selection process. The literature group, the mean age of subjects was 25.2 years old, and
search initially identified 201 studies, of which 118 were the proportion of male was 64%. In the non-autologous
non-duplicate. Initially, 28 articles published between group, the mean age of subjects was 42.0 years old, and the
1999 and 2022 were selected based on the inclusion and proportion of males was 16.5%.
exclusion criteria for the present review of the literature.
Eighteen articles were quantitatively analyzed following 3.5. Pre-operative characteristics
full-text analysis of the initial selected articles. These In total, the mean pre-operative GCS was 13.5, and time to
included 1 retrospective cohort study, 8 case series, and initial encounter was 1.9 days. The proportion of fracture
9 case reports (Table 1) [7-9,16-30] . Five studies were conducted location was 44% frontal, 30% parietal, 15% occipital, and
in the United States, three in China, and one each in 11% temporal across the total patient sample. With respect
Brazil, Egypt, Germany, India, Indonesia, Japan, Nigeria, to the autologous group, mean preoperative GCS was
South Korea, Switzerland, and Turkey (10). 12.8. Mean time to encounter was 1.67 days. Location of
3.2. Qualitative analysis fracture was 36% frontal, 33% parietal, 17% occipital, and
14% temporal. In the non-autologous group, pre-operative
The eighteen studies were assessed with appropriate GCS was 14.8. Mean time to encounter was 2.68 days.
guidelines to characterize their quality based on several Location of fracture was 68% frontal, 22% parietal,
criteria (Table 2). NOS scores of 7–9 were deemed sufficient and 10% occipital. There was no statistically significant
for the study as it fell in the region of high-quality study difference between the two groups for preoperative GCS
according to the NOS guidelines. The single retrospective (p = 0.1570), time to encounter (p = 0.4785), or fracture
cohort study was analyzed with the NOS for cohort location (p = 0.09) (Table 3).
studies. For case reports/series which had a maximum
of 7, sufficient studies included those dissatisfying only 1 3.6. Perioperative characteristics
item per domain at maximum, with a total score of 5/7.
The single cohort study scored a 7. Six case reports/series Decision for cranioplasty was reported in 97% of the
scored a 6 and eleven case reports/series scored a 5. surgically treated patients. Mean length to cranioplasty
11.4 days. In the autologous group, mean length to
3.3. Analysis of confounding variables cranioplasty was 10.3 days. The non-autologous group had
From the extracted data, potential confounders were a mean length to cranioplasty of 16.1 days. There was no
analyzed with respect to the two categories of implant difference between the two groups for days to cranioplasty
type, that is, autologous and nonautologous. This included (p = 0.4780) (Table 3).
the age, gender, duration to hospital encounter, pre- 3.7. Post-operative outcomes
operative GCS, and fracture location. With respect to all
variables, barring age, there were no statistically significant The overall complication rate was 4.0%% including
differences observed between autologous versus non- two cases of intraoperative epidural hematoma and
autologous implant material. Age within the autologous postoperative wound infection. The mean post-operative
patient sample set was skewed toward younger patients, GCS was 14.95. The mean length of stay was 18.6 days for the
particularly in a study by AbdelFatah et al. Removal total sample size. Finally, the overall minimum follow-up
[16]
of this study in the same analysis revealed a transition to time was 1.2 years. In the autologous group, the mean post-
non-statistical significance of age. With this in mind, the operative GCS was 15, while the non-autologous group had
study was included for outcome analysis acknowledging a mean of 14.74. In the autologous group, complication
the large sample of younger patients in this study skewed rate was 4.14%, and in the non-autologous group, the rate
autologous patient age toward the left. was 3.13%. There was no difference in complication rate
(p = 0.8584). The autologous group had an average LOS
3.4. Synthesis of results of 36.3 days, and the non-autologous group had a LOS of
The sample size across all studies was 177 patients after 16.7 days. In the autologous group, minimum follow-up
application of inclusion and exclusion criteria. The mean time was 1.21 years, and in the non-autologous group,
age was 30.77 years. There were 152 males (85.9%). the rate was 0.93 years (Table 4). There was a significant
Regarding duraplasty implant material, 82% utilized difference for GCS (p < 0.0001), LOS (p = 0.0274), and
autologous pericranial grafts, 16% titanium mesh, 1% minimum follow-up time (p = 0.000796).

Volume 2 Issue 1 (2023) 4 https://doi.org/10.36922/an.247