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Perez CF, Gordon CR. Neuroplastic Surgery Principles of Computerized Surgical Planning in Complex Cranioplasty Reconstruction. Semin Plast Surg 2024; 38:189-197. [PMID: 39118861 PMCID: PMC11305828 DOI: 10.1055/s-0044-1786759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
This article explores the evolution and implementation of three-dimensional (3D) models and Computerized Surgical Planning (CSP) for complex cranioplasty reconstruction and the advances in neuroplastic surgery principles for improved surgical outcomes. Over recent years, CSP has revolutionized the field by employing detailed medical imaging to enhance the accuracy and efficacy of 3D models and for the creation of customized cranial implants (CCIs). The study discusses the advancements of solid alloplastic implants to the future of implants with sophisticated and integrated neurotechnology to treat or enhance patient outcomes. CSP can be used to identify and mitigate complications that can occur within cranioplasty reconstruction and to create CCIs to address the postoperative challenge of temporal hollowing. Despite the promising advancements, the article acknowledges the current limitations of CSP, including cost and technological accessibility, and proposes future directions for research and development. The findings suggest that with further improvements in imaging, biomaterials, and manufacturing techniques, CSP in neuroplastic surgery and other specialties will continue to significantly enhance the precision and personalized care of cranioplasty reconstruction.
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Affiliation(s)
- Colleen F. Perez
- Divison of Neuroplastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Chad R. Gordon
- Division of Neuroplastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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2
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Podgoršak A, Flürenbrock F, Trimmel NE, Korn L, Oertel MF, Stieglitz L, Fernandes Dias S, Hierweger MM, Zeilinger M, Weisskopf M, Schmid Daners M. Toward the "Perfect" Shunt: Historical Vignette, Current Efforts, and Future Directions. Adv Tech Stand Neurosurg 2024; 50:1-30. [PMID: 38592526 DOI: 10.1007/978-3-031-53578-9_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
As a concept, drainage of excess fluid volume in the cranium has been around for more than 1000 years. Starting with the original decompression-trepanation of Abulcasis to modern programmable shunt systems, to other nonshunt-based treatments such as endoscopic third ventriculostomy and choroid plexus cauterization, we have come far as a field. However, there are still fundamental limitations that shunts have yet to overcome: namely posture-induced over- and underdrainage, the continual need for valve opening pressure especially in pediatric cases, and the failure to reinstall physiologic intracranial pressure dynamics. However, there are groups worldwide, in the clinic, in industry, and in academia, that are trying to ameliorate the current state of the technology within hydrocephalus treatment. This chapter aims to provide a historical overview of hydrocephalus, current challenges in shunt design, what members of the community have done and continue to do to address these challenges, and finally, a definition of the "perfect" shunt is provided and how the authors are working toward it.
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Affiliation(s)
- Anthony Podgoršak
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Fabian Flürenbrock
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Nina Eva Trimmel
- Center for Preclinical Development, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Leonie Korn
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Markus Florian Oertel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lennart Stieglitz
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandra Fernandes Dias
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Melanie Michaela Hierweger
- Center for Preclinical Development, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Melanie Zeilinger
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Miriam Weisskopf
- Center for Preclinical Development, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marianne Schmid Daners
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.
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3
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Yang M, Ye Z, Ren Y, Farhat M, Chen PY. Materials, Designs, and Implementations of Wearable Antennas and Circuits for Biomedical Applications: A Review. MICROMACHINES 2023; 15:26. [PMID: 38258145 PMCID: PMC10819388 DOI: 10.3390/mi15010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
The intersection of biomedicine and radio frequency (RF) engineering has fundamentally transformed self-health monitoring by leveraging soft and wearable electronic devices. This paradigm shift presents a critical challenge, requiring these devices and systems to possess exceptional flexibility, biocompatibility, and functionality. To meet these requirements, traditional electronic systems, such as sensors and antennas made from rigid and bulky materials, must be adapted through material science and schematic design. Notably, in recent years, extensive research efforts have focused on this field, and this review article will concentrate on recent advancements. We will explore the traditional/emerging materials for highly flexible and electrically efficient wearable electronics, followed by systematic designs for improved functionality and performance. Additionally, we will briefly overview several remarkable applications of wearable electronics in biomedical sensing. Finally, we provide an outlook on potential future directions in this developing area.
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Affiliation(s)
- Minye Yang
- State Key Laboratory for Manufacturing Systems Engineering, Electronic Materials Research Laboratory, Key Laboratory of the Ministry of Education, Engineering Research Center of Spin Quantum Sensor Chips, Universities of Shaanxi Province, School of Electronic Science and Engineering, Xi’an Jiaotong University, Xi’an 710049, China
- Department of Electrical and Computer Engineering, University of Illinois Chicago, Chicago, IL 60607, USA; (Z.Y.); (Y.R.); (P.-Y.C.)
| | - Zhilu Ye
- Department of Electrical and Computer Engineering, University of Illinois Chicago, Chicago, IL 60607, USA; (Z.Y.); (Y.R.); (P.-Y.C.)
- State Key Laboratory for Manufacturing Systems Engineering, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Center for Mitochondrial Biology and Medicine, School of Life Science and Technology, International Joint Laboratory for Micro/Nano Manufacturing and Measurement Technology, Xi’an Key Laboratory for Biomedical Testing and High-end Equipment, Xi’an Jiaotong University, Xi’an 710049, China
| | - Yichong Ren
- Department of Electrical and Computer Engineering, University of Illinois Chicago, Chicago, IL 60607, USA; (Z.Y.); (Y.R.); (P.-Y.C.)
| | - Mohamed Farhat
- Division of Computer, Electrical and Mathematical Sciences and Engineering, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia;
| | - Pai-Yen Chen
- Department of Electrical and Computer Engineering, University of Illinois Chicago, Chicago, IL 60607, USA; (Z.Y.); (Y.R.); (P.-Y.C.)
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4
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Chen K, Liang W, Zhu Q, Shen H, Yang Y, Li Y, Li H, Wang Y, Qian R. Clinical Outcomes After Cranioplasty With Titanium Mesh, Polyetheretherketone, or Composite Bone Cement: A Retrospective Study. J Craniofac Surg 2023; 34:2246-2251. [PMID: 37470720 PMCID: PMC10597434 DOI: 10.1097/scs.0000000000009542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/20/2023] [Indexed: 07/21/2023] Open
Abstract
Cranioplasty is a common neurosurgical procedure; however, the optimal material choice remains controversial. At the time of this writing, autologous bone, the preferred choice for primary cranioplasty, has a high incidence of complications such as infection and resorption, thus requiring frequent use of synthetic materials. Therefore, this study aimed to compare the clinical benefits of titanium mesh (Ti), polyetheretherketone (PEEK), and composite bone cement (CBC) in cranioplasty to provide a clear selection basis for clinicians and patients. This study retrospectively collected data from 207 patients who underwent cranioplasty with Ti (n=129), PEEK (n=54), and CBC (n=24) between January 2018 and December 2020 at Henan Provincial People's Hospital. Postoperative follow-up information after 6 months was used to compare the long-term effects of the 3 materials on the patients. There were no significant differences in the overall complication rate after cranioplasty among the 3 materials. However, subcutaneous effusion was more frequent with PEEK (24.07%) and CBC (20.83%) than with Ti (2.33%). Second, there were no significant differences in the increase in Glasgow Outcome Scale and Karnofsky Performance Status scores after cranioplasty among the 3 materials. Finally, we found that PEEK had the highest patient satisfaction and hospitalization cost, whereas the opposite was true for Ti. Although the surgical outcomes of the 3 implant materials were similar, an examination of clinical outcomes such as patient satisfaction showed significant differences, deepening people's perceptions of the 3 materials.
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Affiliation(s)
- Kui Chen
- Henan University People’s Hospital, Henan Provincial People’s Hospital
| | - Wenjia Liang
- Henan University People’s Hospital, Henan Provincial People’s Hospital
| | - Qingyun Zhu
- School of Clinical Medicine, Henan University, Henan Provincial People’s Hospital
| | - Haoyu Shen
- Zhenzhou University People’s Hospital, Henan Provincial People’s Hospital
| | - Youlei Yang
- Henan University People’s Hospital, Henan Provincial People’s Hospital
- Zhenzhou University People’s Hospital, Henan Provincial People’s Hospital
| | - Yanxin Li
- Zhenzhou University People’s Hospital, Henan Provincial People’s Hospital
| | - Haichun Li
- Department of Neurosurgery, Henan Provincial People’s Hospital
| | - Yonghong Wang
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University
| | - Rongjun Qian
- Department of Neurosurgery, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou University People’s Hospital, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
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5
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Zaramo TZ, Zelko I, Ragland D, Tunyi J, Kaur MN, Bajestani N, Lee CN, Chung KC, Mitchell KAS. Can we do better at measuring patient-reported outcomes after cranioplasty? A systematic review. Neurosurg Rev 2023; 46:109. [PMID: 37148399 PMCID: PMC10163856 DOI: 10.1007/s10143-023-02006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/23/2023] [Accepted: 04/23/2023] [Indexed: 05/08/2023]
Abstract
Measuring quality of life (QOL) after cranioplasty is increasingly evident as a necessary component of patient-centered care. For data to be useful in clinical decision-making and approval of new therapies, studies must utilize valid and reliable instruments. Our objective was to critically appraise studies evaluating QOL in adult cranioplasty patients and determine validity and relevance of the patient-reported outcome measures (PROMs) used. Electronic databases of PubMed, Embase, CINAHL, and PsychINFO were used to identify PROMs measuring QOL in adult patients with cranioplasty. The methodological approach, cranioplasty outcomes, and domains measured by the PROMs were extracted and summarized descriptively. A content analysis of the identified PROMs was completed to identify the concepts measured. From 2236 articles identified, 17 articles containing eight QOL PROMs met the inclusion criteria. None of the PROMs was specifically validated or developed for adults undergoing cranioplasty. The QOL domains included physical health, psychological health, social health, and general QOL. These four domains encompassed 216 total items among the PROMs. Appearance was only assessed in two PROMs. To our knowledge, there are currently no validated PROMs that comprehensively measure appearance, facial function, and adverse effects in adults undergoing cranioplasty. There is an urgent need to develop PROMs to measure QOL outcomes rigorously and comprehensively in this patient population to inform clinical care, research, and quality improvement initiatives. Findings from this systematic review will be used to derive an outcome instrument containing important concepts related to QOL in patients who undergo cranioplasty.
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Affiliation(s)
- Taborah Z Zaramo
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Ian Zelko
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Dashaun Ragland
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Jude Tunyi
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Manraj N Kaur
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nojan Bajestani
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Clara N Lee
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kerry-Ann S Mitchell
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA.
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da Silva Junior EB, Hamasaki EE, Smaili HY, Wozniak A, Tristão ESY, Loureiro MDP, Milano JB, de Meneses MS, de Oliveira RM, Ramina R. Fiber-Optic Intracranial Pressure Monitoring System Using Wi-Fi-An In Vivo Study. Neurosurgery 2023; 92:647-656. [PMID: 36512829 DOI: 10.1227/neu.0000000000002250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Continuous invasive monitoring of intracranial pressure (ICP) is essential in neurocritical care for surveillance and management of raised ICP. Fluid-based systems and strain gauge microsensors remain the current standard. In the past few decades, several studies with wireless monitoring were developed aiming to reduce invasiveness and complications. OBJECTIVE To describe a novel Wi-Fi fiber-optic device for continuous ICP monitoring using smartphone in a swine model. METHODS Two ICP sensors (wireless prototype and wire-based reference) were implanted in the cerebral parenchyma of a swine model for a total of 120 minutes of continuous monitoring. Every 5 minutes, jugular veins compression was performed to evaluate ICP changes. The experimentation was divided in 3 phases for comparison and analysis. RESULTS Phase 1 showed agreement in ICP changes for both sensors during jugular compression and releasing, with a positive and strong Spearman correlation (r = 0.829, P < .001). Phase 2 started after inversion of the sensors in the burr holes; there was a positive and moderately weak Spearman correlation (r = 0.262, P < .001). For phase 3, the sensors were returned to the first burr holes; the prototype behaved similarly to the reference sensor, presenting a positive and moderately strong Spearman correlation (r = 0.669, P < .001). CONCLUSION A Wi-Fi ICP monitoring system was demonstrated in a comprehensive and feasible way. It was possible to observe, using smartphone, an adequate correlation regarding ICP variations. Further adaptations are already being developed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ricardo Ramina
- Department of Neurosurgery, Instituto de Neurologia de Curitiba, Curitiba, Brazil
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7
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Let's Smarten Up: Smart Devices and the Internet of Things, an Untapped Resource for Innovation in Craniofacial Surgery. J Craniofac Surg 2023; 34:413-414. [PMID: 36441646 DOI: 10.1097/scs.0000000000009124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022] Open
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Discussion on: "Let's Smarten Up: Smart Devices and the Internet of Things, an Untapped Resource for Innovation in Craniofacial Surgery". J Craniofac Surg 2023; 34:414-416. [PMID: 36608085 PMCID: PMC9794149 DOI: 10.1097/scs.0000000000009125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 12/31/2022] Open
Abstract
Prior to Dr. Paul Tessier's teachings in the 1960's, many neurosurgeons and craniofacial surgeons took shortcuts and employed alloplastic materials fraught with complication, and soon thereafter, both surgical specialties moved the pendulum towards the side of bone grafts being the gold standard for neurosurgical reconstruction and the art of cranioplasty. But now half a century later, neuroplastic surgery is moving the pendulum the other way. Without a doubt, the brain is a critical organ that needs some form of modulation as opposed to replacement. The intervention delivered can be in the form of electricity, light, medicine, etc. Regardless of the medium, it needs to be housed somewhere. And there is no better real estate than to be housed within a sterile alloplastic case with embedded smart technologies; in a way that prevents obvious, visual deformity. For example, it would be naïve to think that the future of embedded neurotechnologies will one day be housed safely and dependably within one's own bone flap. Hence, moving forward, time-tested alloplastic materials will become the new gold standard for cranioplasty reconstruction as the world starts to welcome a generation of smart cranial devices; some of which may house Bluetooth-connected, Wifi-enabled, MRI-compatible pumps to perform convection-enhanced delivery of time-tested medicines - thereby forever changing the way we approach chronic neurological disease and the forever-obstructing, blood-brain barrier. As this happens, I feel confident saying that both Tessier and Cushing are somewhere applauding and smiling on these efforts.
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9
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Fuessinger MA, Metzger MC, Rothweiler R, Brandenburg LS, Schlager S. Cranial reconstruction evaluation - comparison of European statistical shape model performance on Chinese dataset. Bone Rep 2022; 17:101611. [PMID: 36120645 PMCID: PMC9478677 DOI: 10.1016/j.bonr.2022.101611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Morphological variability of the skull is an important consideration for cranioplasty and implant design. Differences in morphology of the skull based on the ethnicity are known. In a previous study we could show the accuracy and benefits of virtual reconstructions based on a statistical shape model (SSM) for neurocranial defects. As the SSM is trained on European data, the question arises how well this model fares when dealing with patients with a different ethnic background. In this study we aim to evaluate the accuracy and applicability of our proposed method when deploying a cranial SSM generated from European data to estimate missing parts of the neurocranium in a Chinese population. Methods We used the same data and methods as in our previous study and compared the outcomes when applied to Chinese individuals. A large unilateral defect on the right side and a bilateral defect were created. The outer surface of the cranial table was reconstructed from CT scans, meshed with triangular elements, and registered to a template. Principal component analysis together with Thin Plate Spines (TPS) deformation was applied to quantify modes of variation. The mesh to mesh distances between the original defects´ surfaces and the reconstructed surface were computed. Results Comparing the Chinese test group with the European control group, regarding the entire defect the analysis shows no significant difference for unilateral defects (test vs. control group/0.46 mm ± vs. 0.44 mm). Reconstruction of bilateral defects exhibited only in slightly higher prediction errors than those of unilateral defects (0.49 mm ± vs. 0.45 mm). Conclusion The proposed method shows a high accuracy that seems to be ethnical independent - with low error margins for virtual skull reconstruction and implant design. Clinical relevance: Metallic objects may severely impact image quality in several CBCT devices. Statistical shape modelling enables automatic skull reconstruction for computer assisted surgery Despite a Caucasian database, the statistical shape model can provide accurate results for other ethnic groups. The results facilitate the development of reconstruction algorithms, as the data basis can be kept smaller
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Affiliation(s)
- Marc Anton Fuessinger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Rene Rothweiler
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Stefan Schlager
- Department of Physical Anthropology, Albert-Ludwigs University Freiburg, Hebelstr. 29, 79104 Freiburg, Germany
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10
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Rossitto CP, Devarajan A, Price G, Ali M, Kellner CP. Neuroimaging through Sonolucent Cranioplasty: A Systematic Scoping Review Protocol. Methods Protoc 2022; 5:mps5050080. [PMID: 36287052 PMCID: PMC9612145 DOI: 10.3390/mps5050080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
Cranioplasty is a neurosurgical procedure in which the skull bone is repaired after craniectomy. Recently, studies have suggested that sonolucent synthetic materials are safe and useful for cranioplasty. Sonolucent cranioplasty (SC) implants provide unprecedented opportunity in adult neurosurgery to monitor neuroanatomy, assess hemodynamics, view devices located within the implant, and conduct focused ultrasound treatments. Current research on SC includes proof-of-concept cadaveric studies, patient-related safety and feasibility studies, and case series demonstrating transcranioplasty ultrasonography (TCUS). The purpose of this protocol is to investigate the current literature on SC use and outcomes in TCUS. We will perform a systematic literature search following PRISMA-ScR guidelines. The search will be conducted using Ovid Embase, Ovid Medline, and Web of Science Core Collection databases. Titles, abstracts, and full texts will be screened. Joanna Briggs Institute critical appraisal tools will be utilized. Data extraction points will include subject characteristics, SC implant characteristics, ultrasound characteristics, and sonographic findings. These findings will provide a comprehensive review of the literature on sonolucent cranioplasty and directions for future research.
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11
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Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, Ashammakhi N. Implants with Sensing Capabilities. Chem Rev 2022; 122:16329-16363. [PMID: 35981266 DOI: 10.1021/acs.chemrev.2c00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.
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Affiliation(s)
- Mladen Veletić
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ehsanul Hoque Apu
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48105, United States
| | - Mitar Simić
- Faculty of Electrical Engineering, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jacob Bergsland
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ilangko Balasingham
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Department of Bioengineering, University of California, Los Angeles, California 90095, United States
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12
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Grillo W, Boateng CA, Brady LJ, Gaudier-Diaz MM, Mitchell KA, Ruffin VA, Tejdeda HA, Marshall SA. Reflections of six neuroscientists: The influences of training at minority serving institutions. J Neurosci Res 2022; 100:1529-1537. [PMID: 33527411 PMCID: PMC9942539 DOI: 10.1002/jnr.24796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/28/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Wendy Grillo
- Department of Biological & Biomedical Sciences, North Carolina Central University, Durham, NC, USA
| | - Comfort A. Boateng
- Department of Basic Pharmaceutical Sciences, Fred Wilson School of Pharmacy, High Point University, NC, USA
| | - Lillian J. Brady
- Department of Pharmacology, Vanderbilt Center for Addiction Research, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Monica M. Gaudier-Diaz
- Department of Psychology & Neuroscience, University of North Carolina-Chapel Hill, NC, USA
| | - Kerry-Ann Mitchell
- Department of Plastic & Reconstructive Surgery, The Ohio State University, Columbus, OH, USA
| | - Vernon A. Ruffin
- Department of Natural Sciences, Virginia Union University, Richmond, VA, USA
| | - Hugo A. Tejdeda
- Intramural Research Program, National Institute on Drug Abuse, US National Institutes of Health, Baltimore, MD, USA
| | - S. Alex Marshall
- Department of Biological & Biomedical Sciences, North Carolina Central University, Durham, NC, USA,Department of Psychology & Neuroscience, University of North Carolina-Chapel Hill, NC, USA
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13
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The Use of the Three-Dimensional Printed Polyether Ether Ketone Implant in Secondary Craniosynostosis Revision. J Craniofac Surg 2022; 33:1734-1738. [PMID: 35762609 DOI: 10.1097/scs.0000000000008618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Skull deformities may be seen in patients years after craniosynostosis correction. These deformities cause psychosocial distress in affected patients. In this series, the authors describe the use of patient specific polyether ether ketone (PEEK) implants for correction of skull deformities after cranial vault remodeling for craniosynostosis. METHODS A chart review was conducted for 3 revision procedures performed by 1 plastic surgeon in collaboration with 1 neurosurgeon, both affiliated with Northwell Health. Preoperative computed tomography scans were used to design three-dimensional (3D) printed PEEK implants manufactured by KLS Martin. Implants were used to correct frontal and orbital asymmetry and skull deformities in each patient. Outcomes were assessed at 1 week, 1 month, and 3 months post-operation. RESULTS Two males and 1 female, ages 13, 17, and 19, underwent revision cranioplasty or orbital rim reconstruction using a custom, single piece 3D printed PEEK implant. All 3 patients underwent cranial vault remodeling in infancy; 1 was treated for coronal craniosynostosis and 2 were treated for metopic craniosynostosis. Revision cranioplasty operative times were 90, 105, and 147 minutes, with estimated blood loss of 45 mL, 75 mL, and 150 mL, respectively. One patient went home on post op day 1 and 2 patients went home on post op day 2. All patients had an immediate improvement in structural integrity and cranial contour, and all patients were pleased with their aesthetic results. CONCLUSIONS Custom 3D printed PEEK implants offer a single piece solution in revision cranioplasty surgery to correct skull deformities after cranial vault remodeling for craniosynostosis.
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Mee H, Clement C, Anwar F, Whiting G, Timofeev I, Helmy A, Hutchinson PJ, Kolias AG. Exploring the experiences and challenges for patients undergoing cranioplasty: a mixed-methods study protocol. BMJ Open 2022; 12:e048072. [PMID: 35459659 PMCID: PMC9036468 DOI: 10.1136/bmjopen-2020-048072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/11/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cranioplasty is a widely practised neurosurgical procedure aimed at reconstructing a skull defect, but its impact on a patient's rehabilitation following a traumatic brain injury (TBI) or stroke could be better understood. In addition, there are many issues that a TBI patient or the patient who had a stroke and their families may have to adapt to. Insight into some of the potential social barriers, including issues related to social engagement and cosmetic considerations, would be beneficial. Currently, little is known about how this procedure impacts a patient's recovery, the patient's perceptions of rehabilitation precranioplasty and postcranioplasty and the broader issues of cosmesis and social reintegration. This study hopes to understand some of these issues and therefore help inform clinicians of some of the difficulties and perceptions that patients and their relatives may have. METHODS AND ANALYSIS A mixed-methods study. Data will be collected through focus groups with healthcare professionals (HCPs) and semi-structured interviews with patients and their relatives, field notes, a researcher diary and a patient questionnaire. Different perspectives will be brought together through method triangulation. Patient and relative data will be analysed using interpretive phenomenological analysis, and HCPs data will be analysed thematically using deductive and inductive coding. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Wales REC 7 ethics committee (Rec ref: 19/WA/0315). There is limited literature regarding a patient's perception of the cranioplasty process, the potential impact on rehabilitation and how this may impact their reintegration into the community. The results of this study will be presented at national brain injury conferences and published in peer-reviewed, national and international journals.
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Affiliation(s)
- Harry Mee
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Clare Clement
- School of Social and Community Medicine, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Fahim Anwar
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gemma Whiting
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ivan Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter John Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Cranioplasty Outcomes From 500 Consecutive Neuroplastic Surgery Patients. J Craniofac Surg 2022; 33:1648-1654. [PMID: 35245275 DOI: 10.1097/scs.0000000000008546] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/21/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cranioplasty is critical to cerebral protection and restoring intracranial physiology, yet this procedure is fraught with a high risk of complications. The field of neuroplastic surgery was created to improve skull and scalp reconstruction outcomes in adult neurosurgical patients, with the hypothesis that a multidisciplinary team approach could help decrease complications. OBJECTIVE To determine outcomes from a cohort of cranioplasty surgeries performed by a neuroplastic surgery team using a consistent surgical technique and approach. METHODS The authors reviewed 500 consecutive adult neuroplastic surgery cranioplasties that were performed between January 2012 and September 2020. Data were abstracted from a prospectively maintained database. Univariate analysis was performed to determine association between demographic, medical, and surgical factors and odds of revision surgery. RESULTS Patients were followed for an average of 24 months. Overall, there was a reoperation rate of 15.2% (n = 76), with the most frequent complications being infection (7.8%, n = 39), epidural hematoma (2.2%, n = 11), and wound dehiscence (1.8%, n = 9). New onset seizures occurred in 6 (1.2%) patients. Several variables were associated with increased odds of revision surgery, including lower body mass ratio, 2 or more cranial surgeries, presence of hydrocephalus shunts, scalp tissue defects, large-sized skull defect, and autologous bone flaps. Importantly, implants with embedded neurotechnology were not associated with increased odds of reoperation. CONCLUSIONS These results allow for comparison of multiple factors that impact risk of complications after cranioplasty and lay the foundation for development of a cranioplasty risk stratification scheme. Further research in neuroplastic surgery is warranted to examine how designated centers concentrating on adult neuro-cranial reconstruction and multidisciplinary collaboration may lead to improved cranioplasty outcomes and decreased risks of complications in neurosurgical patients.
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Dabbour AH, Tan S, Kim SH, Guild SJ, Heppner P, McCormick D, Wright BE, Leung D, Gallichan R, Budgett D, Malpas SC. The Safety of Micro-Implants for the Brain. Front Neurosci 2021; 15:796203. [PMID: 34955740 PMCID: PMC8695845 DOI: 10.3389/fnins.2021.796203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Technological advancements in electronics and micromachining now allow the development of discrete wireless brain implantable micro-devices. Applications of such devices include stimulation or sensing and could enable direct placement near regions of interest within the brain without the need for electrode leads or separate battery compartments that are at increased risk of breakage and infection. Clinical use of leadless brain implants is accompanied by novel risks, such as migration of the implant. Additionally, the encapsulation material of the implants plays an important role in mitigating unwanted tissue reactions. These risks have the potential to cause harm or reduce the service of life of the implant. In the present study, we have assessed post-implantation tissue reaction and migration of borosilicate glass-encapsulated micro-implants within the cortex of the brain. Twenty borosilicate glass-encapsulated devices (2 × 3.5 × 20 mm) were implanted into the parenchyma of 10 sheep for 6 months. Radiographs were taken directly post-surgery and at 3 and 6 months. Subsequently, sheep were euthanized, and GFAP and IBA-1 histological analysis was performed. The migration of the implants was tracked by reference to two stainless steel screws placed in the skull. We found no significant difference in fluoroscopy intensity of GFAP and a small difference in IBA-1 between implanted tissue and control. There was no glial scar formation found at the site of the implant’s track wall. Furthermore, we observed movement of up to 4.6 mm in a subset of implants in the first 3 months of implantation and no movement in any implant during the 3–6-month period of implantation. Subsequent histological analysis revealed no evidence of a migration track or tissue damage. We conclude that the implantation of this discrete micro-implant within the brain does not present additional risk due to migration.
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Affiliation(s)
- Abdel-Hameed Dabbour
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Sheryl Tan
- Centre for Brain Research, Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Sang Ho Kim
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Sarah-Jane Guild
- Auckland Bioengineering Institute, Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Peter Heppner
- Auckland District Health Board, Auckland, New Zealand
| | - Daniel McCormick
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Bryon E Wright
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Dixon Leung
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Robert Gallichan
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - David Budgett
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Simon C Malpas
- Auckland Bioengineering Institute, Department of Physiology, University of Auckland, Auckland, New Zealand
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Direct Consequences of Cranioplasty to the Brain: Intracranial Pressure Study. J Craniofac Surg 2021; 32:2779-2783. [PMID: 34727479 DOI: 10.1097/scs.0000000000007945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Intracranial pressure (ICP) is a crucial factor that we need to take into account in all major pathophysiological changes of the brain after decompressive craniectomy (DC) and cranioplasty (CP). The purpose of our study was to check ICP values before and after cranioplasty and its relation to various parameters (imaging, demographics, time of cranioplasty, and type of graft) as well as its possible relation to postsurgical complications. The authors performed a prospective study in which they selected as participants adults who had undergone unilateral frontotemporoparietal DC and were planned to have cranioplasty. Intracranial pressure was measured with optical fiber sensor in the epidural space and did not affect cranioplasty in any way.Twenty-five patients met the criteria. The mean vcICP (value change of ICP) was 1.2 mm Hg, the mean ΔICP (absolute value change of the ICP) was 2.24 mm Hg and in the majority of cases there was an increase in ICP. The authors found 3 statistically significant correlations: between gender and ΔICP, Δtime (time between DC and CP) and vcICP, and pre-ICP and ±ICP (quantitative change of the ICP).Μale patients tend to develop larger changes of ICP values during CP. As the time between the 2 procedures (DC and CP) gets longer, the vcICP is decreased. However, after certain time it shows a tendency to remain around zero. Lower pre-ICP values (close to or below zero) are more possible to increase after bone flap placement. It seems that the brain tends to restore its pre-DC conditions after CP by taking near-to-normal ICP values.
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Clinical improvement after cranioplasty and its relation to body position and cerebral hemodynamics. Neurosurg Rev 2021; 45:1463-1472. [PMID: 34626266 DOI: 10.1007/s10143-021-01668-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 10/04/2021] [Indexed: 12/24/2022]
Abstract
Cranioplasty after decompressive craniectomy (DC) has been found to improve the neurological condition. The underlying mechanisms are still unknown. The aim of this study is to investigate the roles of the postural changes and atmospheric pressure (AP) in the brain hemodynamics and their relationship with clinical improvement. Seventy-eight patients were studied before and 72 h after cranioplasty with cervical and transcranial color Doppler ultrasound (TCCS) in the sitting and supine positions. Craniectomy size, shape, and force exerted by the AP (torque) were calculated. Neurological condition was assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Barthel index. Twenty-eight patients improved after cranioplasty. Their time elapsed from the DC was shorter (214 vs 324 days), preoperative Barthel was worse (54 vs 77), internal carotid artery (ICA) mean velocity of the defect side was lower while sitting (14.4 vs 20.9 cm/s), and torque over the craniectomy was greater (2480.3 vs 1464.3 N*cm). Multivariate binary logistic regression showed the consistency of these changes. TCCS findings were no longer present postoperatively. Lower ICA (defect side) velocity in the sitting position correlates significantly with clinical improvement. Greater torque exerted by the AP might explain different susceptibilities to postural changes, corrected by cranioplasty.
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Affiliation(s)
- Chad R Gordon
- Section of Neuroplastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Mitchell KA, Gordon C. Discussion of Surgical and Patient-Reported Outcomes in Patients With PEEK Versus Titanium Cranioplasty Reconstruction. J Craniofac Surg 2020; 32:198-200. [DOI: 10.1097/scs.0000000000007193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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The Neuroplastic Surgery Fellowship Experience: Where Tradition Meets Innovation. J Craniofac Surg 2020; 32:12-14. [DOI: 10.1097/scs.0000000000007201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Advantages of Small Bone-Window Craniotomy Under Microscope Combined Postoperative Intracranial Pressure Monitoring in the Treatment of Hypertensive Intracerebral Hemorrhage. J Craniofac Surg 2020; 32:e77-e80. [PMID: 32897975 DOI: 10.1097/scs.0000000000006986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study is to analyze the clinical effect of small bone-window craniotomy with microscope combined postoperative ICP monitoring, and further explore an appropriate treatment for HICH patients. METHODS One hundred fifty patients with HICH were selected according to inclusion and exclusion criteria and divided into 3 groups at random, 50 each group. Patients in 3 groups were treated with conventional craniotomy, small bone-window craniotomy and small bone-window craniotomy combined ICP monitoring respectively. The surgical efficiency, treatment effect and outcomes were recorded and analyzed. RESULTS The intraoperative blood loss and operation time of small window groups were significantly less than that of conventional group, and the hematoma clearance rate in small window groups were significantly higher than in conventional group (P < 0.05). Compared with conventional group, the hospital stays and mannitol dose used were less in small window groups and least in small window combined ICP monitoring group (P < 0.05). The complication rate in small window combined ICP monitoring group was 10%, which was significantly lower than in conventional group (26%, P < 0.05), while no significant difference was found between small window group (18%) compared with the other 2 groups respectively (P > 0.05). The difference of morality rate between 3 groups wasn't significant (P > 0.05). Three treatment significantly increased the Barthel index score, and the improvement of small window combined ICP monitoring group was significantly higher than in other 2 groups respectively (P < 0.05), while the difference between this two groups wasn't significant (P > 0.05). CONCLUSION Small bone-window craniotomy is more efficient and convenient than conventional craniotomy in the treatment of HICH. In the meantime, small bone-window craniotomy simultaneous with ICP monitoring significantly improved clinical effect and treatment outcomes of HICH patients.
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