From Incan time to today, the unresolved problem of cranioplasty

[Modern aspects of reconstructive surgery of skull defects]

The aim of this study is to systematize the modern methods used for reconstruction of extensive and complex skull defects. Special attention is paid to computer technologies, including 3D imaging and CAD/CAM. Laser-based stereolithography is thoroughly reviewed among other additive technologies. We present our view of the problem associated with proper timing of cranioplasty and choice of materials for it. Complications of skull defect reconstruction are also discussed.

Efficacy and Versatility of the 3-D Titanium Mesh Implant in the Closure of Large Post-Craniectomy Osseous Defects, and its Therapeutic Role in Reversing the Syndrome of the Trephined: Clinical Study of a Case Series and Review of Literature

INTRODUCTION

An ideal cranioplasty material is one which adequately restores calvarial continuity, contour and esthetics, provides adequate cerebral protection, is biocompatible and corrosion resistant, lightweight yet strong, easy to manipulate and possesses long term stability. The 3-D Titanium mesh implant fulfills most of these criteria, and offers certain added advantages, as exemplified in this case series. Four patients with post craniectomy osseous defects of varying sizes and at different locations of the calvarium were studied. In addition to the obvious cosmetic deformity, the patients also exhibited various subjective and objective features of neurosensory and motor deficits characteristic of the motor trephine syndrome (MTS), that often develops secondary to large cranial defects.

OBJECTIVE

There have been no documented reports so far on the effect of Titanium mesh cranioplasty on features of the MTS in patients with large cranial defects. It was the objective of this study to see if any specific therapeutic goals such as reversal of the neurological deterioration and sensorimotor deficits associated with the syndrome could be achieved by performing Titanium mesh cranioplasty to reconstruct the missing part of the cranial shield in these patients. Any added benefits of using 3-D Titanium mesh as a cranioplasty material were also recorded.

MATERIALS AND METHODS

The cranial defects in all four patients were reconstructed using different dimensions of Titanium mesh implants. Two of the cases were early cranioplasties (performed within 3 months of craniectomy) and two were late cranioplasties (performed after 3 months of craniectomy), one of them even being a previous autologous bone flap cranioplasty failure. The patients were followed up for a period ranging from 3 to 4 years and observed carefully for cosmetic, functional and neurological improvements following the cranioplasty.

RESULTS

There was achieved gratifying cosmetic correction of the cranial deformities, and remarkable functional recovery from the sensorimotor deficits, reversal of the neurological deterioration as well as resolution of most of the symptoms of MTS in all the four patients, following the Titanium mesh cranioplasty. Many added benefits were noted, such as quick post operative recovery, absence of any early or late complications and a ready means to aspirate any epidural collections, if they developed post operatively, through the mesh structure of the implant.

CONCLUSION

Apart from the cosmetic, functional and protective roles, Titanium mesh cranioplasty demonstrated a definite therapeutic role in all the cases presented, making it preferable to even replacement with natural bone (either re-implanted excised autologous bone flaps, or cortico-cancellous bone autografts). It is an extremely safe and reliable alternative to autografts, and is even preferable to them, especially when the size of the cranial defect is large.

Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends

Cranial bone repair is one of the oldest neurosurgical practices. Reconstructing the natural contours of the skull has challenged the ingenuity of surgeons from antiquity to the present day. Given the continuous improvement of neurosurgical and emergency care over the past century, more patients survive such head injuries, thus necessitating more than ever before a simple, safe, and durable means of correcting skull defects. In response, numerous techniques and materials have been devised as the art of cranioplasty has progressed. Although the goals of cranioplasty remain the same, the evolution of techniques and diversity of materials used serves as testimony to the complexity of this task. This paper highlights the evolution of these materials and techniques, with a particular focus on the implications for managing pediatric calvarial repair and emerging trends within the field.