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In complex cases, an interdisciplinary approach is needed between neurosurgeons and cranio-maxillofacial surgeons. We present a considerably large series for which we identify typical complications and pitfalls and provide evidence for the importance of an interdisciplinary algorithm for chronic wound healing complications and malignomas of the scalp and skull. We retrospectively reviewed all patients treated by the department of neurosurgery and cranio-maxillofacial surgery at our hospital for complex scalp deficiencies and malignant scalp tumors affecting the skull between 2006 and 2019, and extracted data on demographics, surgical technique, and perioperative complications. Thirty-seven patients were treated. Most cases were operated simultaneously (<jats:italic>n<\/jats:italic>: 32) and 6 cases in a staged procedure. Nineteen patients obtained a free flap for scalp reconstruction, 15 were treated with local axial flaps, and 3 patients underwent full thickness skin graft treatment. Complications occurred in 62% of cases, mostly related to cerebrospinal fluid (CSF) circulation disorders. New cerebrospinal fluid (CSF) disturbances occurred in 8 patients undergoing free flaps and shunt dysfunction occurred in 5 patients undergoing local axial flaps. Four patients died shortly after the surgical procedure (perioperative mortality 10.8%). Combined scalp and skull deficiency present a challenging task. An interdisciplinary treatment helps to prevent severe and specialty-specific complications, such as hydrocephalus. We therefore recommend a close neurological observation after reconstructive treatment with focus on symptoms of CSF disturbances.<\/jats:p>","DOI":"10.1007\/s10143-020-01347-7","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T23:06:09Z","timestamp":1594335969000},"page":"1583-1589","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["CSF disturbances and other neurosurgical complications after interdisciplinary reconstructions of large combined scalp and skull deficiencies"],"prefix":"10.1007","volume":"44","author":[{"given":"Vicki M.","family":"Butenschoen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochen","family":"Weitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas M.","family":"Ritschl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4050-1531","authenticated-orcid":false,"given":"Sandro M.","family":"Krieg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,7,10]]},"reference":[{"key":"1347_CR1","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1097\/SCS.0b013e3181e17c1e","volume":"21","author":"A Afifi","year":"2010","unstructured":"Afifi A, Djohan RS, Hammert W, Papay FA, Barnett AE, Zins JE (2010) Lessons learned reconstructing complex scalp defects using free flaps and a cranioplasty in one stage. 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SK and BM received research grants from and are consultants for Brainlab AG (Munich, Germany). BM received honoraria, consulting fees, and research grants from Medtronic (Meerbusch, Germany), icotec ag (Altst\u00e4tten, Switzerland), and Relievant Medsystemy Inc. (Sunnyvale, CA, USA); honoraria and research grants from Ulrich Medical (Ulm, Germany); honoraria and consulting fees from Spineart Deutschland GmbH (Frankfurt, Germany) and DePuy Synthes (West Chester, PA, USA); and royalties from Spineart Deutschland GmbH (Frankfurt, Germany). All authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}