{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T14:47:36Z","timestamp":1793285256418,"version":"4.5.0"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>While numerous studies have evaluated cranioplasty outcomes after decompressive craniectomy, most rely on heterogeneous cohorts with insufficient follow-up. The aim of this near-nationwide multicenter study was to review 15 years of cranial reconstructions in Sweden to establish the rates of complications and shunt dependence, as well as the extent of functional recovery, and to characterize the factors associated with these outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients treated with primary cranioplasty after decompressive craniectomy from January 2008 to December 2022 were included. Patient medical records were reviewed for demographic and technical details, as well as surgical outcomes and shunt dependency. Functional recovery was determined before surgery and 6 months after cranioplasty using the modified Rankin Scale. Multivariable regression models (adjusted for confounders) were used to evaluate outcome predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 725 patients (median age 49 years [IQR 33\u201359 years]) who underwent cranioplasty, autologous bone was used in 74%. The median follow-up duration was 80 months and 31% of patients underwent at least 1 reoperation. Long-term cranioplasty failure rates were significantly lower with synthetic implants, primarily due to a 15% revision rate caused by bone flap resorption in autologous cranioplasties. Resorption was most pronounced in patients younger than 40 years of age, while infection rates were comparable across different implant materials. One hundred patients (14%) received a permanent shunt, which was associated with the nature of the primary brain injury, cranial defect size, and external brain herniation prior to cranioplasty. Functional improvement was observed in 26% of patients following cranioplasty, and significantly more frequently in younger patients with fewer comorbidities, those who underwent earlier cranioplasty, and those with a history of malignant middle cerebral artery infarction or subarachnoid hemorrhage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Cranioplasty outcomes after decompressive craniectomy were benchmarked and several outcome predictors were identified. Particularly, reoperation rates remain at alarming levels and suggest that a change in policy from an autograft- to alloplast-first strategy should be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.jns25925","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:39:26Z","timestamp":1768570766000},"page":"857-867","source":"Crossref","is-referenced-by-count":3,"title":["Cranioplasty outcomes after decompressive craniectomy: a near-nationwide population-based study based on 15 years of cranial reconstructions in Sweden"],"prefix":"10.3171","volume":"144","author":[{"given":"Klas","family":"Holmgren","sequence":"first","affiliation":[{"name":"Department of Clinical Science - Neurosciences, Ume\u00e5 University, Ume\u00e5;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Fjellborg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science - Neurosciences, Ume\u00e5 University, Ume\u00e5;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science - Neurosciences, Ume\u00e5 University, Ume\u00e5;"},{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Lindvall","sequence":"additional","affiliation":[{"name":"Department of Clinical Science - Neurosciences, Ume\u00e5 University, Ume\u00e5;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Corell","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg;"},{"name":"Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dima","family":"Harba","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Fletcher-Sandersj\u00f6\u00f6","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm;"},{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrik","family":"Birgersson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm;"},{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institute, Huddinge;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bjartur","family":"S\u00e6mundsson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm;"},{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"\u00c5gren","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm;"},{"name":"Department of Physiology and Pharmacology, Karolinska Institute, Stockholm; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Kihlstr\u00f6m Burenstam Linder","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm;"},{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Sundblom","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"Ryttlefors","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodor","family":"Svedung Wettervik","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Acta Neurochir (Wien)","first-page":"388","article-title":"Indications and scientific support for supratentorial unilateral decompressive craniectomy for different subgroups of patients: a scoping review","volume":"166","author":"Beucler N","year":"2024","unstructured":"Beucler N. 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Complications following cranioplasty using autologous bone or polymethylmethacrylate\u2014retrospective experience from a single center. Clin Neurol Neurosurg. 2013;115(9):1788\u20131791."},{"issue":"1","key":"b4","series-title":"Acta Neurochir (Wien)","first-page":"438","article-title":"The role of autologous bone in cranioplasty. A systematic review of complications and risk factors by using stored bone","volume":"166","author":"Birgersson U","year":"2024","unstructured":"Birgersson U, Wettervik T, Sundblom J, Kihlstr\u00f6m Burenstam Linder L. The role of autologous bone in cranioplasty. A systematic review of complications and risk factors by using stored bone. 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J Clin Neurosci. 2016;33:39\u201351."},{"issue":"1-2","key":"b11","series-title":"Acta Neurochir (Wien)","first-page":"21","article-title":"Effect of cranioplasty on cerebrospinal fluid hydrodynamics in patients with the syndrome of the trephined","volume":"70","author":"Fodstad H","year":"1984","unstructured":"Fodstad H, Love JA, Ekstedt J, Frid\u00e9n H, Liliequist B. Effect of cranioplasty on cerebrospinal fluid hydrodynamics in patients with the syndrome of the trephined. Acta Neurochir (Wien). 1984;70(1-2):21\u201330."},{"key":"b12","series-title":"Brain Spine","first-page":"102761","article-title":"Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel","volume":"4","author":"Iaccarino C","year":"2024","unstructured":"Iaccarino C, Chibbaro S, Sauvigny T,  Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel. 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