To analyze the risk factors for epidural hemorrhage/effusion after cranioplasty and discuss preventive and therapeutic measures.

A retrospective analysis was conducted on 463 patients who underwent cranioplasty in Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from December 2016 to October 2023. Patients were divided into two groups based on whether there was postoperative hematoma/effusion: the group with hematoma/effusion and the group without hematoma/effusion. The clinical data of the two groups were compared, and multiple Logistic regression analysis was used to screen for prognostic factors.

Among the 463 cranioplasty patients, 37 developed postoperative epidural hemorrhage/effusion, with an incidence rate of 7.99%. Among them, 33 patients improved after sufficient drainage using a drainage tube and urokinase perfusion, while 4 patients required a second craniotomy to evacuate the hemorrhage/effusion. The intergroup comparison showed that there were statistically significant differences in gender, unilateral/simultaneous bilateral repair, intraoperative blood loss, drainage tube type, and negative pressure suction between the two groups of patients (P<0.05); Multivariate Logistic regression analysis of factors with P<0.1 revealed that advanced age, male gender, simultaneous bilateral cranioplasty, and the use of a Branden external drainage system were independent risk factors for postoperative epidural hematoma/effusion following cranioplasty (P<0.05).

Advanced age, male gender, simultaneous bilateral cranioplasty, and the use of a Branden external drainage system were independent risk factors for postoperative epidural hematoma/effusion following cranioplasty. Attention to these risk factors during the perioperative period, improvement of surgical techniques, strict adherence to standardized procedures, thorough hemostasis and effective postoperative drainage can significantly reduce the incidence of epidural hemorrhage/effusion or even hematoma after cranioplasty.