Cranioplasty (CP) is a standard procedure in neurosurgical practice for patients after (decompressive) craniectomy. However, CP surgery is not standardized, is carried out in different ways, and is associated with considerable complication rates. Here, we report our experiences with the use of different CP materials and analyze long-term complications and implant survival rates. We retrospectively studied patients who underwent CP surgery at our institution between 2004 and 2014. Binary logistic regression analysis was performed in order to identify risk factors for the development of complications. Kaplan-Meier analysis was used to estimate implant survival rates. A total of 392 patients (182 females, 210 males) with a mean age of 48 years were included. These patients underwent a total of 508 CP surgeries. The overall complication rate of primary CP was 33.2%, due to bone resorption/loosening (14.6%) and graft infection (7.9%) with a mean implant survival of 120 ± 5 months. Binary logistic regression analysis showed that young age (< 30 years) (p = 0.026, OR 3.150), the presence of multidrug-resistant bacteria (p = 0.045, OR 2.273), and cerebrospinal fluid (CSF) shunt (p = 0.001, OR 3.137) were risk factors for postoperative complications. The use of titanium miniplates for CP fixation was associated with reduced complication rates and bone flap osteolysis as well as longer implant survival rates. The present study highlights the risk profile of CP surgery. Young age (< 30 years) and shunt-dependent hydrocephalus are associated with postoperative complications especially due to bone flap autolysis. Furthermore, a rigid CP fixation seems to play a crucial role in reducing complication rates.

颅骨成形术 (CP) 是（减压）颅骨切除术后患者神经外科实践中的标准程序。然而，CP 手术并不规范，以不同的方式进行，并且与相当大的并发症发生率相关。在这里，我们报告了我们使用不同 CP 材料的经验，并分析了长期并发症和种植体存活率。我们回顾性研究了 2004 年至 2014 年在我们机构接受 CP 手术的患者。进行了二元逻辑回归分析，以确定发生并发症的风险因素。Kaplan-Meier 分析用于估计种植体存活率。共纳入平均年龄 48 岁的 392 名患者（182 名女性，210 名男性）。这些患者共接受了 508 次 CP 手术。由于骨吸收/松动 (14.6%) 和移植物感染 (7.9%)，原发性 CP 的总体并发症发生率为 33.2%，平均种植体存活时间为 120 ± 5 个月。二元逻辑回归分析表明，年轻（<30 岁）（p  = 0.026, OR 3.150)、多重耐药菌的存在 ( p  = 0.045, OR 2.273) 和脑脊液 (CSF) 分流 ( p  = 0.001, OR 3.137) 是术后并发症的危险因素。使用钛微型钢板进行 CP 固定与降低并发症发生率和骨瓣骨质溶解以及更长的种植体存活率相关。本研究强调了 CP 手术的风险概况。年轻（<30 岁）和分流依赖性脑积水与术后并发症有关，尤其是由于骨瓣自溶。此外，刚性 CP 固定似乎在降低并发症发生率方面起着至关重要的作用。