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Oh SY, Kim HY, Jung SY, Kim HS. Tissue Engineering and Regenerative Medicine in the Field of Otorhinolaryngology. Tissue Eng Regen Med 2024:10.1007/s13770-024-00661-1. [PMID: 39017827 DOI: 10.1007/s13770-024-00661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 06/21/2024] [Accepted: 06/30/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Otorhinolaryngology is a medical specialty that focuses on the clinical study and treatments of diseases within head and neck regions, specifically including the ear, nose, and throat (ENT), but excluding eyes and brain. These anatomical structures play significant roles in a person's daily life, including eating, speaking as well as facial appearance and expression, thus greatly impacting one's overall satisfaction and quality of life. Consequently, injuries to these regions can significantly impact a person's well-being, leading to extensive research in the field of tissue engineering and regenerative medicine over many years. METHODS This chapter provides an overview of the anatomical characteristics of otorhinolaryngologic tissues and explores the tissue engineering and regenerative medicine research in otology (ear), rhinology (nose), facial bone, larynx, and trachea. RESULTS AND CONCLUSION The integration of tissue engineering and regenerative medicine in otorhinolaryngology holds the promise of broadening the therapeutic choices for a wide range of conditions, ultimately improving quality of a patient's life.
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Affiliation(s)
- Se-Young Oh
- Department of Convergence Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Ha Yeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Soo Yeon Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Han Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
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Perozzo FAG, Ku YC, Kshettry VR, Sikder P, Papay FA, Rampazzo A, Bassiri Gharb B. High-Density Porous Polyethylene Implant Cranioplasty: A Systematic Review of Outcomes. J Craniofac Surg 2024; 35:1074-1079. [PMID: 38682928 DOI: 10.1097/scs.0000000000010135] [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: 09/14/2023] [Accepted: 02/07/2024] [Indexed: 05/01/2024] Open
Abstract
Porous polyethylene has been widely used in craniofacial reconstruction due to its biomechanical properties and ease of handling. The objective of this study was to perform a systematic review of the literature to summarize outcomes utilizing high-density porous polyethylene (HDPP) implants in cranioplasty. A literature search of PubMed, Cochrane Library, and Scopus databases was conducted to identify original studies with HDPP cranioplasty from inception to March 2023. Non-English articles, commentaries, absent indications or outcomes, and nonclinical studies were excluded. Data on patient demographics, indications, defect size and location, outcomes, and patient satisfaction were extracted. Summary statistics were calculated using weighted averages based on the available reported data. A total of 1089 patients involving 1104 cranioplasty procedures with HDPP were identified. Patients' mean age was 44.0 years (range 2 to 83 y). The mean follow-up duration was 32.0 months (range 2 wk to 8 y). Two studies comprising 17 patients (1.6%) included only pediatric patients. Alloplastic cranioplasty was required after treatment of cerebrovascular diseases (50.9%), tumor excision (32.0%), trauma (11.4%), trigeminal neuralgia/epilepsy (3.4%), and others such as abscesses/cysts (1.4%). The size of the defect ranged from 3 to 340 cm 2 . An overall postoperative complication rate of 2.3% was identified, especially in patients who had previously undergone surgery at the same site. When data were available, contour improvement and high patient satisfaction were reported in 98.8% and 98.3% of the patients. HDPP implants exhibit favorable outcomes for reconstruction of skull defects. Higher complication rates may be anticipated in secondary cranioplasty cases.
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Affiliation(s)
| | - Ying C Ku
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Varun R Kshettry
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Foundation, Cleveland, OH
| | - Prabaha Sikder
- Mechanical Engineering, Cleveland State University, Cleveland, OH
| | - Francis A Papay
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Antonio Rampazzo
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Bahar Bassiri Gharb
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
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Al Alawi K, Al Furqani A, Al Shaqsi S, Shummo M, Al Jabri A, Al Balushi T. Cranioplasty in Oman: Retrospective review of cases from the National Craniofacial Center 2012-2022. Sultan Qaboos Univ Med J 2024; 24:250-258. [PMID: 38828246 PMCID: PMC11139372 DOI: 10.18295/squmj.3.2024.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 06/05/2024] Open
Abstract
Objectives Cranioplasty is a complex craniofacial and neurosurgical procedure that aims to reinstate the architecture of the cranial vault and elevate both its aesthetic and neurological function. Several reconstructive materials have been thoroughly explored in the search for the optimal solution for cranioplasty. This study aimed to evaluate different material used for cranial reconstruction in Oman. Methods This retrospective study included all patients who had had cranioplasty procedures performed at Khoula Hospital, Muscat, Oman, from 2012 to 2022. Demographic information, the characteristics of the cranial defect and any complications that occurred post-operatively were analysed. Results A total of 47 patients were included in this study. The most common cause of cranial defects was craniectomy following traumatic head injury (70.2%) along with excision of fibrous dysplasia (10.6%). The most frequently utilised material for cranial repair was autologous bone grafts (n = 28), followed by polyetheretherketone (PEEK; n = 14). Interestingly, the replacement of bone grafts from previous craniectomy showed a notably high resorption rate (71.4%), in contrast to split calvarial grafts (0%) and other types of bone grafts (14.3%). Additionally, delayed graft infection was observed in 3.6% of the bone graft group and 7.1% of the PEEK group. Conclusion Patient-specific alloplastic implants such as PEEK have gained popularity for large and complex cranioplasty, as they provide excellent aesthetic outcomes and leave no donor site morbidity. In contrast, bone grafts remain the gold standard for small to medium-sized cranial defects.
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Affiliation(s)
- Khalifa Al Alawi
- Department of Plastic & Reconstructive Surgery, Khoula Hospital, Muscat, Oman
| | - Asma Al Furqani
- Department of Plastic & Reconstructive Surgery, Khoula Hospital, Muscat, Oman
| | - Sultan Al Shaqsi
- Department of Plastic & Reconstructive Surgery, University of Toronto, Toronto, Canada
| | - Moath Shummo
- Department of Plastic & Reconstructive Surgery, Khoula Hospital, Muscat, Oman
| | - Ahmed Al Jabri
- Department of Plastic & Reconstructive Surgery, Khoula Hospital, Muscat, Oman
| | - Taimoor Al Balushi
- Department of Plastic & Reconstructive Surgery, Khoula Hospital, Muscat, Oman
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4
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He L. Biomaterials for Regenerative Cranioplasty: Current State of Clinical Application and Future Challenges. J Funct Biomater 2024; 15:84. [PMID: 38667541 PMCID: PMC11050949 DOI: 10.3390/jfb15040084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Acquired cranial defects are a prevalent condition in neurosurgery and call for cranioplasty, where the missing or defective cranium is replaced by an implant. Nevertheless, the biomaterials in current clinical applications are hardly exempt from long-term safety and comfort concerns. An appealing solution is regenerative cranioplasty, where biomaterials with/without cells and bioactive molecules are applied to induce the regeneration of the cranium and ultimately repair the cranial defects. This review examines the current state of research, development, and translational application of regenerative cranioplasty biomaterials and discusses the efforts required in future research. The first section briefly introduced the regenerative capacity of the cranium, including the spontaneous bone regeneration bioactivities and the presence of pluripotent skeletal stem cells in the cranial suture. Then, three major types of biomaterials for regenerative cranioplasty, namely the calcium phosphate/titanium (CaP/Ti) composites, mineralised collagen, and 3D-printed polycaprolactone (PCL) composites, are reviewed for their composition, material properties, and findings from clinical trials. The third part discusses perspectives on future research and development of regenerative cranioplasty biomaterials, with a considerable portion based on issues identified in clinical trials. This review aims to facilitate the development of biomaterials that ultimately contribute to a safer and more effective healing of cranial defects.
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Affiliation(s)
- Lizhe He
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou 310028, China
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5
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Ng JJ, Blum JD, Cheung L, Cho DY, Romeo DJ, Kalmar CL, Villavisanis DF, Bartlett SP, Taylor JA, Swanson JW. Autologous Cranioplasty Using a Dental SafeScraper Device. Plast Reconstr Surg 2024; 153:612e-616e. [PMID: 37053449 DOI: 10.1097/prs.0000000000010550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
SUMMARY Conventional methods to reconstruct cortical bone defects introduced by pediatric cranial vault remodeling (CVR) procedures have shortcomings. Use of bone burr shavings as graft material leads to variable ossification, and harvesting split-thickness cortical grafts is time-intensive and often not possible in thin infant calvaria. Since 2013, the authors' team has used the SafeScraper, originally developed as a dental instrument, to harvest cortical and cancellous bone grafts during CVR. The authors assessed the effectiveness of this technique by analyzing postoperative ossification using computed tomography scans of 52 patients, comparing cohorts treated with the SafeScraper versus those who received conventional methods of cranioplasty during fronto-orbital advancement. The SafeScraper cohort had a greater reduction in total surface area of all defects (-83.1% ± 14.9 versus -68.9% ± 29.8; P = 0.034), demonstrating a greater and more consistent degree of cranial defect ossification compared with conventional methods of cranioplasty, suggesting potential adaptability of this tool. This is the first study that describes the technique and efficacy of the SafeScraper in reducing cranial defects in CVR. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Jinggang J Ng
- From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania
| | - Jessica D Blum
- From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
| | - Liana Cheung
- From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
| | - Daniel Y Cho
- From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
| | - Dominic J Romeo
- From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania
| | - Christopher L Kalmar
- From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
| | - Dillan F Villavisanis
- From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
| | - Scott P Bartlett
- From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
| | - Jesse A Taylor
- From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
| | - Jordan W Swanson
- From the Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia
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Kopačin V, Zubčić V, Mumlek I, Mužević D, Rončević A, Lazar AM, Pavić AK, Koruga AS, Krivdić Z, Martinović I, Koruga N. Personalized 3D-printed cranial implants for complex cranioplasty using open-source software. Surg Neurol Int 2024; 15:39. [PMID: 38468644 PMCID: PMC10927182 DOI: 10.25259/sni_906_2023] [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: 11/10/2023] [Accepted: 01/19/2024] [Indexed: 03/13/2024] Open
Abstract
Background Cranioplasty is a routine neurosurgery treatment used to correct cranial vault abnormalities. Utilization of 3D printing technology in the field of cranioplasty involving the reconstruction of cranial defects emerged as an advanced possibility of anatomical reshaping. The transformative impact of patient-specific 3D printed implants, focuses on their remarkable accuracy, customization capabilities, and enhanced biocompatibility. Methods The precise adaptation of implants to patient-specific anatomies, even in complex cases we presented, result in improved aesthetic outcomes and reduced surgical complications. The ability to create highly customized implants addresses the functional aspects of cranial defects and considers the psychological impact on patients. Results By combining technological innovation with personalized patient care, 3D printed cranioplasty emerges as a transformative avenue in cranial reconstruction, ultimately redefining the standards of success in neurosurgery. Conclusion 3D printing allows an excellent cranioplasty cosmesis achieved at a reasonable price without sacrificing patient outcomes. Wider implementation of this strategy can lead to significant healthcare cost savings.
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Affiliation(s)
- Vjekoslav Kopačin
- Department of Diagnostic and Interventional Radiology, University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
| | - Vedran Zubčić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Ivan Mumlek
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Dario Mužević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurosurgery, University Hospital Center, Osijek, Croatia
| | - Alen Rončević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurosurgery, University Hospital Center, Osijek, Croatia
| | - Ana-Maria Lazar
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Ana Kvolik Pavić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Anamarija Soldo Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurology, University Hospital Center, Osijek, Croatia
| | - Zdravka Krivdić
- Department of Diagnostic and Interventional Radiology, University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
| | - Ivana Martinović
- Department of Information Sciences, Faculty of Humanities and Social Sciences, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Nenad Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurosurgery, University Hospital Center, Osijek, Croatia
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Ockerman KM, Cox EA, Wiesemann G, Nichols DS, Murad GJA, Ching J, Sorice-Virk S. Healing Exposed Calvarial Hardware Using Negative-Pressure Wound Therapy and Vashe Wound Solution: Case Report. Adv Skin Wound Care 2023; 36:385-391. [PMID: 37224465 DOI: 10.1097/01.asw.0000926628.10995.fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The management of cranioplasty infections has historically been explantation followed by delayed reimplantation/reconstruction. This treatment algorithm necessitates surgery, tissue expansion, and prolonged disfigurement. In this report, the authors describe a treatment approach consisting of serial vacuum-assisted closure (VAC) with hypochlorous acid (HOCl) solution (Vashe Wound Solution; URGO Medical) as a salvage strategy. METHODS A 35-year-old man who sustained head trauma, neurosurgical complications, and severe syndrome of the trephined (SOT; devastating neurologic decline treated by cranioplasty) underwent titanium cranioplasty with free flap. Three weeks postoperation, he presented with pressure-related wound dehiscence/partial flap necrosis, exposed hardware, and bacterial infection. Given the severity of his precranioplasty SOT, hardware salvage was critical. He was treated with serial VAC with HOCl solution for 11 days followed by VAC for 18 days and definitive split-thickness skin graft placement over resulting granulation tissue. Authors also conducted a literature review of cranial reconstruction infection management. RESULTS The patient remained healed 7 months postoperatively without recurrent infection. Importantly, his original hardware was retained, and his SOT remained resolved. Findings from the literature review support the use of conservative modalities to salvage cranial reconstructions without hardware removal. CONCLUSIONS This study investigates a new strategy for managing cranioplasty infections. The VAC with HOCl solution regimen was effective in treating the infection and salvaging the cranioplasty, thus obviating the complications associated with explantation, new cranioplasty, and recurrence of SOT. There is limited literature on the management of cranioplasty infections using conservative treatments. A larger study to better determine the efficacy of VAC with HOCl solution is underway.
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Affiliation(s)
- Kyle M Ockerman
- At the University of Florida College of Medicine, Gainesville, Florida, USA, Kyle M. Ockerman, BS, and Gayle Wiesemann, BS, are Medical Students; Gregory J. A. Murad, MD, is Full Clinical Professor, Department of Neurosurgery; Jessica Ching, MD, is Assistant Professor, Division of Plastic and Reconstructive Surgery; and Sarah Sorice-Virk, MD, is Assistant Professor, Division of Plastic and Reconstructive Surgery. At Stanford University School of Medicine, Palo Alto, California, Elizabeth A. Cox, MD, is Resident, Division of Plastic and Reconstructive Surgery. At Duke University School of Medicine, Durham, North Carolina, D. Spencer Nichols, MD, is Resident, Division of Plastic and Reconstructive Surgery
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8
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Riordan E, Yung A, Cheng K, Lim L, Clark J, Rtshiladze M, Ch'ng S. Modeling Methods in Craniofacial Virtual Surgical Planning. J Craniofac Surg 2023; 34:1191-1198. [PMID: 36806300 DOI: 10.1097/scs.0000000000009187] [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: 06/18/2022] [Accepted: 10/09/2022] [Indexed: 02/22/2023] Open
Abstract
Despite the widespread use of virtual surgical planning (VSP), few papers describe the modeling methods used to generate the digital simulations that underpin VSP. This paper aims to review the modeling methods that are currently available for use in VSP and the implications of their use in clinical practice. A literature review was undertaken of the two broad categories of modeling techniques; contour-based planning-namely mirroring from the contralateral side, templating from a normative database, and extrapolation from surrounding landmarks-and occlusal-based planning (OBP). The indications for each modeling method were discussed, including mandibular/maxillary reconstruction, pediatric craniofacial surgery, and orthognathic, as well as the limitations to the accuracy of modeling types. Unilateral defects of the upper/midface, wherein contour accuracy is paramount, are best reconstructed using mirroring methods, whereas bilateral defects-or cases with asymmetry due to craniofacial dysmorphology-are most suited to normative-data-based methods. Cases involving resection of the alveolar margin, in which functional occlusion is the primary outcome are best managed with OBP. Similarly, orthognathic surgery typically uses OBP, although complex cases involving asymmetry, such as clefts, may benefit from a combination of OBP and normative data methods. The choice of modeling methods is, therefore, largely driven by the defect type and the goals of reconstruction.
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Affiliation(s)
- Edward Riordan
- Department of Plastic Surgery, St George Hospital
- Melanoma Institute Australia, The University of Sydney
| | - Amanda Yung
- Melanoma Institute Australia, The University of Sydney
- Sydney Medical School, University of Sydney
| | - Kai Cheng
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
| | - Lydia Lim
- Department of Maxillofacial Surgery, Westmead Hospital
| | - Jonathan Clark
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
- Faculty of Medicine and Health, The University of Sydney
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre
| | - Michael Rtshiladze
- Melanoma Institute Australia, The University of Sydney
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital Randwick
- Department of Plastic Surgery, Prince of Wales Hospital
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
- Faculty of Medicine and Health, The University of Sydney
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Zhang R, Gao Z, Zhu YJ, Wang XF, Wang G, He JP. Spontaneous fracture of a titanium mesh cranioplasty implant in a child: A case report. World J Clin Cases 2023; 11:1593-1599. [PMID: 36926410 PMCID: PMC10011976 DOI: 10.12998/wjcc.v11.i7.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/15/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Titanium mesh cranioplasty is often performed after decompressive craniectomy. Spontaneous fracture of the titanium prosthesis is an extremely rare postoperative complication. Here, we report a 10-year-old boy who presented with a spontaneous fracture of titanium mesh without antecedent head trauma.
CASE SUMMARY A 10-year-old boy presented with a 1-wk history of a tender bulge over the left temporo-parieto-occipital scalp. He had undergone a temporo-parieto-occipital titanium mesh cranioplasty 26 mo previously. He denied antecedent head trauma. Computerized tomography disclosed a perpendicular fissure in the titanium mesh, suggesting a diagnosis of spontaneous titanium mesh fracture. He underwent a second temporo-parieto-occipital cranioplasty and made an uneventful recovery. Three-dimensional modeling and finite element analyses were used to explore potential risk factors of titanium mesh fracture.
CONCLUSION We report a case of spontaneous fracture of a titanium mesh cranioplasty implant. The current case and literature review indicate that titanium mesh implants should be well-anchored to the base of bony defects to prevent fatigue-induced fractures.
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Affiliation(s)
- Rui Zhang
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
| | - Zhe Gao
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
| | - Yong-Jie Zhu
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
| | - Xin-Fa Wang
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
| | - Gang Wang
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
| | - Jun-Ping He
- Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University, Nanjing 21000, Jiangsu Province, China
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Current Concepts in Cranial Reconstruction: Review of Alloplastic Materials. Plast Reconstr Surg Glob Open 2022; 10:e4466. [PMID: 35999885 PMCID: PMC9390815 DOI: 10.1097/gox.0000000000004466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/03/2022] [Indexed: 11/25/2022]
Abstract
Cranioplasty for acquired cranial defects can be complex and challenging. Benefits include improved cosmesis, protection of intracranial structures, and restoration of neurocognitive function. These defects can be reconstructed with preserved craniectomy bone flaps, split autografts, or alloplastic materials. When alloplastic cranioplasty is planned, the material should be carefully selected. There is confusion on which material should be used in certain scenarios, particularly in composite defects.
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11
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The Multiple Rib Osteomyocutaneous Split Latissimus Dorsi Flap for Calvarial Reconstruction: Indication, Operative Technique, and Review of Literature. J Craniofac Surg 2022; 33:2631-2637. [PMID: 35905389 DOI: 10.1097/scs.0000000000008754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/02/2022] [Indexed: 11/26/2022] Open
Abstract
Major complex cranial defects may be challenging for the reconstructive microsurgeon. Affected patients often present with impaired soft tissues including dura exposure or fistulas. The lacking structural bony support may cause severe neurological issues and in select patients, there is a need for well-vascularized autologous tissue repair. The authors herein elucidate the role of the multiple rib osteomyocutaneous split latissimus dorsi flap for reconstruction of composite skull defects, providing an indication, an exemplary case, operation technique, and literature review. A 40-year-old woman after anaplastic oligodendroglioma resection suffered multiple extrusions and allograft cranioplasty infections. The defect was reconstructed with an osteomyocutaneus split latissimus dorsi flap including costae 3 ribs and a skin island. The included ribs were nourished via the anterior periosteum, while the posterior periosteum was left in place for the protection of the pleura parietalis. A proper amount of craniomedial latissimus dorsi muscle was spared to reduce donor site morbidity. The patient presented after 6 months with stable bony and soft tissue conditions without neurological symptoms, and acceptable donor site morbidity. After failed alloplastic cranioplasties, the free latissimus dorsi flap including vascularized ribs is well suitable for coverage of large compound cranial defects, providing skeletal support, improved contour, and enhanced functional outcome.
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12
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Spake CS, Goli R, Beqiri D, Crozier JW, Cielo DJ, Klinge PM, Svokos K, Woo AS. Evidence of linear bone flap resorption in patients undergoing autologous cranioplasty following decompressive craniectomy: A 3D Slicer segmented analysis of serial CT images. World Neurosurg 2022; 164:e799-e807. [PMID: 35597539 DOI: 10.1016/j.wneu.2022.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Autologous cranioplasty (CP) following decompressive craniectomy (DC) carries risk of bone flap resorption (BFR). The current literature offers limited information regarding the natural progression of BFR, and the rate at which it occurs. We aim to characterize the progression of BFR over time and elucidate risk factors for accelerated BFR. METHODS A retrospective analysis was conducted on patients who underwent DC and autologous CP. Serial computed tomography (CT) images were used to quantify degree of BFR over time. Risk factors included age, diabetes, smoking status, flap fragmentation, defect size, and DC-CP time interval. Chi-square analyses and Student's t-tests were performed to examine differences between patients who experienced BFR and those who did not. RESULTS Overall, 82% of patients demonstrated evidence of clinically relevant resorption on CT. On average, the bone flap decreased in volume by 36.7% within the first year, with a linear loss in volume after multiple years of follow-up. Individuals who developed greater BFR were significantly younger (43 ± 17 vs. 56 ± 12, p=0.022), had a lower incidence of diabetes (5.9% vs. 43%, p=0.037), and had more bone flap fragments (1.4 ± 0.67 vs. 1.00 ± 0, p <0.001) than those who did not. CONCLUSION Resorption following CP with cryopreserved bone appears to progress in a fairly linear and continuous fashion over time. Using serial CT images, we found a resorption rate of 82% at our institution. We identified several possible risk factors for resorption, including flap fragmentation, younger age, and absence of diabetes.
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Affiliation(s)
- Carole Sl Spake
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Rachna Goli
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Dardan Beqiri
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Joseph W Crozier
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Deus J Cielo
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Petra M Klinge
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Konstantina Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Albert S Woo
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
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Rivera Perla KM, Tang OY, Zeyl VG, Lim R, Rao V, Toms SA, Svokos KA, Woo AS. Predicting the Impact of Race and Socioeconomic Status on Cranioplasty Materials and Outcomes. World Neurosurg 2022; 164:e463-e480. [DOI: 10.1016/j.wneu.2022.04.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
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Kroczek K, Turek P, Mazur D, Szczygielski J, Filip D, Brodowski R, Balawender K, Przeszłowski Ł, Lewandowski B, Orkisz S, Mazur A, Budzik G, Cebulski J, Oleksy M. Characterisation of Selected Materials in Medical Applications. Polymers (Basel) 2022; 14:polym14081526. [PMID: 35458276 PMCID: PMC9027145 DOI: 10.3390/polym14081526] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/19/2022] Open
Abstract
Tissue engineering is an interdisciplinary field of science that has developed very intensively in recent years. The first part of this review describes materials with medical and dental applications from the following groups: metals, polymers, ceramics, and composites. Both positive and negative sides of their application are presented from the point of view of medical application and mechanical properties. A variety of techniques for the manufacture of biomedical components are presented in this review. The main focus of this work is on additive manufacturing and 3D printing, as these modern techniques have been evaluated to be the best methods for the manufacture of medical and dental devices. The second part presents devices for skull bone reconstruction. The materials from which they are made and the possibilities offered by 3D printing in this field are also described. The last part concerns dental transitional implants (scaffolds) for guided bone regeneration, focusing on polylactide–hydroxyapatite nanocomposite due to its unique properties. This section summarises the current knowledge of scaffolds, focusing on the material, mechanical and biological requirements, the effects of these devices on the human body, and their great potential for applications.
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Affiliation(s)
- Kacper Kroczek
- Doctoral School of Engineering and Technical Sciences, Rzeszow University of Technology, 35-959 Rzeszow, Poland;
| | - Paweł Turek
- Faculty of Mechanical Engineering and Aeronautics, Rzeszow University of Technology, 35-959 Rzeszow, Poland; (Ł.P.); (G.B.)
- Correspondence: (P.T.); (D.M.)
| | - Damian Mazur
- Faculty of Electrical and Computer Engineering, Rzeszow University of Technology, 35-959 Rzeszow, Poland
- Correspondence: (P.T.); (D.M.)
| | - Jacek Szczygielski
- Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland; (J.S.); (K.B.); (B.L.); (S.O.); (A.M.)
- Department of Neurosurgery, Faculty of Medicine, Saarland University, 66123 Saarbrücken, Germany
| | - Damian Filip
- Institute of Medical Science, University of Rzeszow, 35-959 Rzeszow, Poland;
| | - Robert Brodowski
- Department of Maxillofacial Surgery, Fryderyk Chopin Clinical Voivodeship Hospital No.1 in Rzeszow, 35-055 Rzeszow, Poland;
| | - Krzysztof Balawender
- Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland; (J.S.); (K.B.); (B.L.); (S.O.); (A.M.)
| | - Łukasz Przeszłowski
- Faculty of Mechanical Engineering and Aeronautics, Rzeszow University of Technology, 35-959 Rzeszow, Poland; (Ł.P.); (G.B.)
| | - Bogumił Lewandowski
- Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland; (J.S.); (K.B.); (B.L.); (S.O.); (A.M.)
- Department of Maxillofacial Surgery, Fryderyk Chopin Clinical Voivodeship Hospital No.1 in Rzeszow, 35-055 Rzeszow, Poland;
| | - Stanisław Orkisz
- Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland; (J.S.); (K.B.); (B.L.); (S.O.); (A.M.)
| | - Artur Mazur
- Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland; (J.S.); (K.B.); (B.L.); (S.O.); (A.M.)
| | - Grzegorz Budzik
- Faculty of Mechanical Engineering and Aeronautics, Rzeszow University of Technology, 35-959 Rzeszow, Poland; (Ł.P.); (G.B.)
| | - Józef Cebulski
- Institute of Physics, University of Rzeszow, 35-959 Rzeszow, Poland;
| | - Mariusz Oleksy
- Faculty of Chemistry, Rzeszow University of Technology, 35-959 Rzeszow, Poland;
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Evaluation of the Fitting Accuracy of CAD/CAM-Manufactured Patient-Specific Implants for the Reconstruction of Cranial Defects-A Retrospective Study. J Clin Med 2022; 11:jcm11072045. [PMID: 35407653 PMCID: PMC9000016 DOI: 10.3390/jcm11072045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 02/04/2023] Open
Abstract
Cranioplasties show overall high complication rates of up to 45.3%. Risk factors potentially associated with the occurrence of postoperative complications are frequently discussed in existing research. The present study examines the positioning of 39 patient-specific implants (PSI) made from polyetheretherketone (PEEK) and retrospectively investigates the relationship between the fitting accuracy and incidence of postoperative complications. To analyze the fitting accuracy of the implants pre- and post-operatively, STL files were created and superimposed in a 3D coordinate system, and the deviations were graphically displayed and evaluated along with the postoperative complications. On average, 95.17% (SD = 9.42) of the measurements between planned and surgically achieved implant position were within the defined tolerance range. In cases with lower accordance, an increased occurrence of complications could not be demonstrated. The overall postoperative complication rate was 64.1%. The fitting of the PEEK-PSI was highly satisfactory. There were predominantly minor deviations of the achieved compared to the planned implant positions; however, estimations were within the defined tolerance range. Despite the overall high accuracy of fitting, a considerable complication rate was found. To optimize the surgical outcome, the focus should instead be directed towards the investigation of other risk factors.
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Yang N, Liu F, Zhang X, Chen C, Xia Z, Fu S, Wang J, Xu J, Cui S, Zhang Y, Yi M, Wan Y, Li Q, Xu S. A Hybrid Titanium-Softmaterial, High-Strength, Transparent Cranial Window for Transcranial Injection and Neuroimaging. BIOSENSORS 2022; 12:bios12020129. [PMID: 35200389 PMCID: PMC8870569 DOI: 10.3390/bios12020129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 05/04/2023]
Abstract
A transparent and penetrable cranial window is essential for neuroimaging, transcranial injection and comprehensive understanding of cortical functions. For these applications, cranial windows made from glass coverslip, polydimethylsiloxane (PDMS), polymethylmethacrylate, crystal and silicone hydrogel have offered remarkable convenience. However, there is a lack of high-strength, high-transparency, penetrable cranial window with clinical application potential. We engineer high-strength hybrid Titanium-PDMS (Ti-PDMS) cranial windows, which allow large transparent area for in vivo two-photon imaging, and provide a soft window for transcranial injection. Laser scanning and 3D printing techniques are used to match the hybrid cranial window to different skull morphology. A multi-cycle degassing pouring process ensures a good combination of PDMS and Ti frame. Ti-PDMS cranial windows have a high fracture strength matching human skull bone, excellent light transmittance up to 94.4%, and refractive index close to biological tissue. Ti-PDMS cranial windows show excellent bio-compatibility during 21-week implantation in mice. Dye injection shows that the PDMS window has a "self-sealing" to keep liquid from leaking out. Two-photon imaging for brain tissues could be achieved up to 450 µm in z-depth. As a novel brain-computer-interface, this Ti-PDMS device offers an alternative choice for in vivo drug delivery, optical experiments, ultrasonic treatment and electrophysiology recording.
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Affiliation(s)
- Nana Yang
- Key Laboratory for the Physics & Chemistry of Nanodevices, Department of Electronics, Peking University, Beijing 100871, China; (N.Y.); (J.X.)
| | - Fengyu Liu
- Neuroscience Research Institute, Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing 100191, China; (C.C.); (S.F.); (J.W.); (S.C.); (Y.Z.); (M.Y.); (Y.W.)
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing 100191, China
- Correspondence: (F.L.); (S.X.)
| | - Xinyue Zhang
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing 100081, China; (X.Z.); (Q.L.)
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
| | - Chenni Chen
- Neuroscience Research Institute, Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing 100191, China; (C.C.); (S.F.); (J.W.); (S.C.); (Y.Z.); (M.Y.); (Y.W.)
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing 100191, China
| | - Zhiyuan Xia
- Department of Material Science and Engineering, College of Engineering, Peking University, Beijing 100871, China;
| | - Su Fu
- Neuroscience Research Institute, Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing 100191, China; (C.C.); (S.F.); (J.W.); (S.C.); (Y.Z.); (M.Y.); (Y.W.)
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing 100191, China
| | - Jiaxin Wang
- Neuroscience Research Institute, Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing 100191, China; (C.C.); (S.F.); (J.W.); (S.C.); (Y.Z.); (M.Y.); (Y.W.)
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing 100191, China
| | - Jingjing Xu
- Key Laboratory for the Physics & Chemistry of Nanodevices, Department of Electronics, Peking University, Beijing 100871, China; (N.Y.); (J.X.)
- School of Microelectronics, Shandong University, Jinan 250100, China
| | - Shuang Cui
- Neuroscience Research Institute, Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing 100191, China; (C.C.); (S.F.); (J.W.); (S.C.); (Y.Z.); (M.Y.); (Y.W.)
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing 100191, China
| | - Yong Zhang
- Neuroscience Research Institute, Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing 100191, China; (C.C.); (S.F.); (J.W.); (S.C.); (Y.Z.); (M.Y.); (Y.W.)
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing 100191, China
| | - Ming Yi
- Neuroscience Research Institute, Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing 100191, China; (C.C.); (S.F.); (J.W.); (S.C.); (Y.Z.); (M.Y.); (Y.W.)
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing 100191, China
| | - You Wan
- Neuroscience Research Institute, Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing 100191, China; (C.C.); (S.F.); (J.W.); (S.C.); (Y.Z.); (M.Y.); (Y.W.)
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing 100191, China
| | - Qing Li
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing 100081, China; (X.Z.); (Q.L.)
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
| | - Shengyong Xu
- Key Laboratory for the Physics & Chemistry of Nanodevices, Department of Electronics, Peking University, Beijing 100871, China; (N.Y.); (J.X.)
- Correspondence: (F.L.); (S.X.)
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Comparison of the Surgical Outcomes of Cranioplasty Using Titanium, Customized Polymethylmethacrylate, and Liquid Polymethylmethacrylate in Maharaj Nakhon Chiang Mai Hospital, Thailand. J Craniofac Surg 2022; 33:1521-1524. [PMID: 34999614 DOI: 10.1097/scs.0000000000008463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Cranioplasty is a standard procedure used to restore skull defects after craniectomy. Many different materials are used in cranioplasty. The study aim was to compare the surgical outcomes of cranioplasty using different materials: liquid polymethylmethacrylate (PMMA), customized PMMA, and titanium. The authors retrospectively reviewed the outcomes of cranioplasty performed from 2016 to 2021. Data collection included patient characteristics and complications, including postoperative infection, hematoma, implant exposure, and subgaleal cerebrospinal fluid collection. Eighty-five patients received cranioplasty with different materials: titanium, 14; customized PMMA, 31; and liquid PMMA, 40. There were no significant differences in the basic patient characteristics among the 3 cranioplasty groups except for lower age in the customized PMMA group. There were no significant differences between superficial and deep infections, implant exposure, postoperative hematoma, or seizure. However, subgaleal cerebrospinal fluid collection was more common in the liquid PMMA group than in the customized PMMA group (P = 0.02). This study showed that good outcomes were achieved by cranioplasty performed with different materials (titanium, customized PMMA, and liquid PMMA).
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Johnson WC, Ravindra VM, Fielder T, Ishaque M, Patterson TT, McGinity MJ, Lacci JV, Grandhi R. Surface Area of Decompressive Craniectomy Predicts Bone Flap Failure after Autologous Cranioplasty: A Radiographic Cohort Study. Neurotrauma Rep 2021; 2:391-398. [PMID: 34901938 DOI: 10.1089/neur.2021.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Skull bone graft failure is a potential complication of autologous cranioplasty after decompressive craniectomy (DC). Our objective was to investigate the association of graft size with subsequent bone graft failure after autologous cranioplasty. This single-center retrospective cohort study included patients age ≥18 years who underwent primary autologous cranioplasty between 2010 and 2017. The primary outcome was bone flap failure requiring graft removal. Demographic, clinical, and radiographic factors were recorded; three-dimensional (3D) reconstructive imaging was used to perform accurate measurements. Univariate and multi-variate regression analysis were performed to identify risk factors for the primary outcome. Of the 131 patients who underwent primary autologous cranioplasty, 25 (19.0%) underwent removal of the graft after identification of bone flap necrosis on computed tomography (CT); 16 (64%) of these were culture positive. The mean surface area of craniectomy defect was 128.5 cm2 for patients with bone necrosis and 114.9 cm2 for those without bone necrosis. Linear regression analysis demonstrated that size of craniectomy defect was independently associated with subsequent bone flap failure; logistic regression analysis demonstrated a defect area >125 cm2 was independently associated with failure (odds ratio [OR] 3.29; confidence interval [CI]: 0.249-2.135). Patient- and operation-specific variables were not significant predictors of bone necrosis. Our results showed that increased size of antecedent DC is an independent risk factor for bone flap failure after autologous cranioplasty. Given these findings, clinicians should consider the increased potential of bone flap failure after autologous cranioplasty among patients whose initial DC was >125 cm2.
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Affiliation(s)
- W Chase Johnson
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Vijay M Ravindra
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California, USA.,Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Tristan Fielder
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Mariam Ishaque
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - T Tyler Patterson
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Michael J McGinity
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - John V Lacci
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
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Trends and Outcomes of Cranioplasty Alone Versus Single-Stage Composite Scalp and Calvarial Reconstruction. J Craniofac Surg 2021; 33:1271-1275. [PMID: 34855630 DOI: 10.1097/scs.0000000000008395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cranioplasty is a critical intervention to restore the calvarium using autologous or alloplastic materials with single-stage composite scalp and calvarial reconstruction reserved for complex cases. This study aims to identify 30-day outcomes in scalp and calvarial reconstruction using the American College of Surgeons National Surgical Quality Improvement Program database. METHODS The authors conducted a retrospective analysis of the 2010 to 2018 American College of Surgeons National Surgical Quality Improvement Program database. Adult patients who underwent cranioplasty were identified using current procedural terminology coding and included by exposure type (autologous, alloplastic, composite, or other). Subjects with missing exposure or outcome data were excluded. Primary outcome was 30-day reoperation, whereas secondary outcomes were 30-day unplanned readmission and transfusion. Univariate analysis was completed to assess differences in demographics, comorbidities, and postoperative complications. Multivariable logistic regression was used to control for confounders. RESULTS In total, 1719 patients underwent cranioplasty (mean age 54.7 ± 15.3 years, 43.5% male), including 169(9.8%) autologous, 1303(75.8%) alloplastic, 32(1.9%) composite, and 215(12.5%) other procedures. Cranioplasty procedures were associated with 30-day complication and mortality rate of 16.5% and 2.4%, respectively. Composite cranioplasty was associated with decreased 30-day reoperation (adjusted odds ratios 0.11, 95% confidence interval 0.014-0.94, P = 0.044). There was no statistically significant difference in readmission between cranioplasty groups. Alloplastic cranioplasty was associated with decreased odds of postoperative transfusion (adjusted odds ratios 0.47, 95% confidence interval 0.27-0.84, P = 0.01). CONCLUSIONS Cranioplasty is an increasingly common procedure. Alloplastic cranioplasty is associated with decreased 30-day transfusion requirement, whereas single-stage composite reconstruction is a viable option and associated with decreased 30-day reoperation with no difference in readmission.
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Yang W, Li J, Li T, Zuo M, Xiang Y, Zhou X, Zheng J, Li H. Different materials of cranioplasty for patients undergoing decompressive craniectomy: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e27936. [PMID: 34964771 PMCID: PMC8615338 DOI: 10.1097/md.0000000000027936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cranioplasty is widely applied on patients who has undergone decompress craniectomy (DC) due to intractable increased intracranial pressure and the cranioplasty materials have been on the bleeding edge of biomolecular and material science. This systematic review and network meta-analysis (NMA) will be conducted to comprehensively evaluate the safety and efficacy of different cranial implants for patients with cranial defects due to various reasons. METHODS AND ANALYSIS This protocol has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The following electronic databases will be searched from the date of database establishment to September 1, 2020: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP, and Wanfang. Randomized controlled trials and non-randomized prospective studies focus on cranial implants will be included. Quality assessment will be conducted using Cochrane Collaboration's tool or risk of bias in nonrandomized studies of interventions based on their study designs. The primary outcome will be postoperative early mortality and implant failure while various complications for secondary outcomes. Pairwise and network meta-analysis will be conducted using STATA V.14 (StataCorp, College Station, Texas, USA). Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the results. ETHICS AND DISSEMINATION This systematic review does not require an ethics approval or the need to obtain informed consent. The results will be published in a peer-reviewed scientific journal. PROTOCOL REGISTRATION NUMBER INPLASY 202110001.
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Application of Human Adipose-Derived Stem cells for Bone Regeneration of the Skull in Humans. J Craniofac Surg 2021; 33:360-363. [PMID: 34636755 DOI: 10.1097/scs.0000000000008114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Archeological archives report cranioplasty as 1 of the oldest surgical procedures; however, it was not until the last century that true advances have been made. Alternative approaches are necessary to achieve optimal closure of the defect with fewer adverse effects. We aim to evaluate the use of human adipose-derived stem cells (hADSCs) alone or seeded in scaffolds as the main treatment for cranial bone defects and to assess human patient outcomes. METHODS A systematic review was performed by querying PubMed, Ovid MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature databases with the MeSH terms: "adipose-derived stem cells," "cranial bone defect," "stromal vascular factor," "fat grafting," as well as synonyms in combinations determined by our search strategy. We included human models that used hADSCs as primary therapy. We excluded studies in languages other than English. RESULTS One hundred ninety-four studies were identified after removal of duplicates. Four articles that used hADSCs as the main therapy to treat calvarial defects in humans were included. One article applied the cell therapy alone, and 3 used β-tricalcium phosphate granules as a scaffold to seed the hADSCs. CONCLUSIONS Bone regeneration was reached in a short and intermediate period using autologous hADSCs in humans with no major adverse effects in all 4 articles included. A long-term follow-up study (6 years) exhibited late infections and reabsorption of the β-tricalcium phosphate scaffold seeded with hADSCs.
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22
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Contemporary Review on Craniectomy and Cranioplasty; Part 2: Material Selection and Plate Manufacture. J Craniofac Surg 2021; 33:842-845. [PMID: 34334754 DOI: 10.1097/scs.0000000000008040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Cranioplasty materials include metals (ie, titanium); ceramics (ie, hydroxyapatite); polymers (ie, poly-methyl-metha-acrylate [PMMA]); and plastics (ie, polyether ether ketone). This paper aims to review their advantages and drawbacks. No ideal material currently exist, however, titanium implants are universally agreed to have lower infection rates than those reported for hydroxyapatite and PMMA implants; thus justifying their current wide use. These implants can be manufactured conventionally from medical grade titanium alloy Ti64 (titanium-aluminum-vanadium) in the form of plates ranging in thickness from 0.5 to 0.7 mm thick, or following the computer-aided design/manufacture principle. Surface finish of these implants is best achieved by electroplating.
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Decision-Making in Adult Cranial Vault Reconstruction. Plast Reconstr Surg 2021; 148:109e-121e. [PMID: 34181619 DOI: 10.1097/prs.0000000000008058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Define and classify different types of cranial defects 2. Compare both autologous and alloplastic options for reconstruction 3. Develop an optimal approach for cranial vault reconstruction in various clinical scenarios. SUMMARY Defects of the cranium result from various causes, including traumatic loss, neurosurgical intervention, skull tumors, and infection. Cranial vault reconstruction aims to restore both the structural integrity and surface morphology of the skull. To ensure a successful outcome, the choice of appropriate cranioplasty reconstruction will vary primarily based on the cause, location, and size of the defect. Other relevant factors that must be considered include adequacy of soft-tissue coverage, presence of infection, and previous or planned radiation therapy. This article presents an algorithm for the reconstruction of various cranial defects using both autologous and alloplastic techniques, with a comparison of their advantages and disadvantages.
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Post-Cranioplasty Complications: Lessons From a Prospective Study Assessing Risk Factors. J Craniofac Surg 2021; 32:530-534. [PMID: 33704976 DOI: 10.1097/scs.0000000000007344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Complication rate related with cranioplasty is described as very high in most of relevant studies. The aim of our study was to try to identify possible factors, that could predict complications following cranioplasty. The authors hypothesized that some physical characteristics on the preoperative brain computed tomography (CT) scan can be predictive for complications.The authors carried out a prospective observational study. All patients were adults after decompressive craniectomy, planned for cranioplasty and had a brain CT scan the day before cranioplasty. Our data pool included demographics, reason of craniectomy, various radiological parameters, the time of cranioplasty after craniectomy, the type of cranioplasty bone flap, and the complications.Twenty-five patients were included in the study. The authors identified statistically significant correlation between time of cranioplasty after craniectomy and the complications, as well as between the type of cranioplasty implant and the complications. There was statistically significant correlation between complications and the distance of the free brain surface from the level of the largest skull defect dimension - free brain surface deformity (FBSD). Moreover, the correlation between FBSD and the time of cranioplasty was statistically significant.It seems that for adult patients with unilateral DC the shorter time interval between craniectomy and cranioplasty lowers the risk for complications. The risk seems to be decreased further, by using autologous bone flap. Low values of the FBSD increase the risk for complications. This risk factor can be avoided, by shortening the time between craniectomy and cranioplasty.
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Thinning of Calvarial Bone by Skull Growth in a Pediatric Patient After Skull Grinding Injury. J Craniofac Surg 2021; 32:e373-e375. [PMID: 33252533 DOI: 10.1097/scs.0000000000007288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Several treatment options have been suggested for the treatment of scalp defects that occur following head trauma. Growth changes should be considered, especially for children. The authors report a case of delayed cranial bone absorption after successful free latissimus dorsi flap coverage following skull grinding injury in a pediatric patient.A 3-year-old patient was referred to the reconstructive surgery department because of a 7 × 8 cm-sized scalp defect in the temporoparietal area due to dragging and grinding injury. Debridement and free latissimus dorsi musculocutaneous flap coverage with split-thickness skin graft were performed. The operation was successful and antibiotics were administered for 4 weeks to prevent the occurrence of osteomyelitis (OM). The patient was discharged after confirming the absence of OM via magnetic resonance imaging.Thinning of cranial bone was observed in the skull series taken one year postoperatively. The size gradually increased, but no significant changes in size occurred after 5 years of patient's age. Magnetic resonance imaging was performed used to confirm the occurrence of OM and no specific findings were observed. It is well-known fact that the cranium grows to 90% of its adult capacity by the age of 5. In this regard, we believe that the current case and the demonstrated cranial thinning is due to bone absorption associated with the growth.In the pediatric population, injuries involving the cranial vault should be considered in the context of bone resorption due to skull growth, which may lead to cranial bone thinning. Reconstructive surgeons should closely observe the presence or absence of skull defects through long-term follow-ups.
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ZHANG QUAN, XU YAWEN, ZHOU JINGYU, PENG BO, ZHANG QIANYU, JIA WEI. NEURAL NETWORK-BASED REPAIRING SKULL DEFECTS: AN INITIAL ASSESSMENT OF PERFORMANCE AND FEASIBILITY. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Accurate 3D reconstruction of the defective part is critically important for repairing defects in the human skull. After investigating the feasibility of 3D convolution neural network (CNN)-based approach, DeepMedic CNN is chosen for repairing defects of the human skull. Training set of 3D CNN model is produced by randomly segmenting the initial 3D model of the skull which come from a whole CT scan of a healthy person. The 3D CNN model was evaluated using a computer-simulated 3D skull model containing the defective part, and in vivo patient. The results showed that based on 160 groups of computer-simulated 3D CT data, the average dice similarity coefficient (DSC), sensitivity (SE) and Hausdorff distance (HD) are 89.31%, 91.81%, and 25.9%, respectively. These quantitative indexes showed that the proposed method is able to do a reliable bone structure predication. For in vivo patient, the obtained model is also able to generate a suitable 3D bone model for the data under consideration. This approach could increase the computational efficiency of the repairing process without the need for segmentation and reconstruction of the skull, and thereby has potential applications to motivating further accurate repairing of defects of skull.
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Affiliation(s)
- QUAN ZHANG
- School of Computer Science, Southwest Petroleum University, Chengdu 610500, P. R. China
- School of Information and Communication Engineering, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China
| | - YAWEN XU
- School of Computer Science, Southwest Petroleum University, Chengdu 610500, P. R. China
| | - JINGYU ZHOU
- School of Computer Science, Southwest Petroleum University, Chengdu 610500, P. R. China
| | - BO PENG
- School of Computer Science, Southwest Petroleum University, Chengdu 610500, P. R. China
| | - QIANYU ZHANG
- School of Computer Science, Southwest Petroleum University, Chengdu 610500, P. R. China
| | - WEI JIA
- Wenjiang District People’s Hospital, Chengdu 611130, P. R. China
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Iaccarino C, Kolias A, Adelson PD, Rubiano AM, Viaroli E, Buki A, Cinalli G, Fountas K, Khan T, Signoretti S, Waran V, Adeleye AO, Amorim R, Bertuccio A, Cama A, Chesnut RM, De Bonis P, Estraneo A, Figaji A, Florian SI, Formisano R, Frassanito P, Gatos C, Germanò A, Giussani C, Hossain I, Kasprzak P, La Porta F, Lindner D, Maas AIR, Paiva W, Palma P, Park KB, Peretta P, Pompucci A, Posti J, Sengupta SK, Sinha A, Sinha V, Stefini R, Talamonti G, Tasiou A, Zona G, Zucchelli M, Hutchinson PJ, Servadei F. Consensus statement from the international consensus meeting on post-traumatic cranioplasty. Acta Neurochir (Wien) 2021; 163:423-440. [PMID: 33354733 PMCID: PMC7815592 DOI: 10.1007/s00701-020-04663-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
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Li J, Gsaxner C, Pepe A, Morais A, Alves V, von Campe G, Wallner J, Egger J. Synthetic skull bone defects for automatic patient-specific craniofacial implant design. Sci Data 2021; 8:36. [PMID: 33514740 PMCID: PMC7846796 DOI: 10.1038/s41597-021-00806-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Abstract
Patient-specific craniofacial implants are used to repair skull bone defects after trauma or surgery. Currently, cranial implants are designed and produced by third-party suppliers, which is usually time-consuming and expensive. Recent advances in additive manufacturing made the in-hospital or in-operation-room fabrication of personalized implants feasible. However, the implants are still manufactured by external companies. To facilitate an optimized workflow, fast and automatic implant manufacturing is highly desirable. Data-driven approaches, such as deep learning, show currently great potential towards automatic implant design. However, a considerable amount of data is needed to train such algorithms, which is, especially in the medical domain, often a bottleneck. Therefore, we present CT-imaging data of the craniofacial complex from 24 patients, in which we injected various artificial cranial defects, resulting in 240 data pairs and 240 corresponding implants. Based on this work, automatic implant design and manufacturing processes can be trained. Additionally, the data of this work build a solid base for researchers to work on automatic cranial implant designs. Measurement(s) | Image Acquisition Matrix Size • Image Slice Thickness • craniofacial region | Technology Type(s) | imaging technique • computed tomography | Sample Characteristic - Organism | Homo sapiens |
Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.13265225
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Affiliation(s)
- Jianning Li
- Institute for Computer Graphics and Vision, Graz University of Technology, Inffeldgasse 16c/II, 8010, Graz, Austria.,Computer Algorithms for Medicine Laboratory, Graz, Austria
| | - Christina Gsaxner
- Institute for Computer Graphics and Vision, Graz University of Technology, Inffeldgasse 16c/II, 8010, Graz, Austria.,Computer Algorithms for Medicine Laboratory, Graz, Austria.,Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 6/1, 8036, Graz, Austria
| | - Antonio Pepe
- Institute for Computer Graphics and Vision, Graz University of Technology, Inffeldgasse 16c/II, 8010, Graz, Austria.,Computer Algorithms for Medicine Laboratory, Graz, Austria
| | - Ana Morais
- Department of Informatics, School of Engineering, University of Minho, Braga, Portugal.,Algoritmi Centre, University of Minho, Braga, Portugal
| | - Victor Alves
- Algoritmi Centre, University of Minho, Braga, Portugal
| | - Gord von Campe
- Department of Neurosurgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Jürgen Wallner
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 6/1, 8036, Graz, Austria.
| | - Jan Egger
- Institute for Computer Graphics and Vision, Graz University of Technology, Inffeldgasse 16c/II, 8010, Graz, Austria. .,Computer Algorithms for Medicine Laboratory, Graz, Austria. .,Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 6/1, 8036, Graz, Austria.
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Surgical and Patient-Reported Outcomes in Patients With PEEK Versus Titanium Cranioplasty Reconstruction. J Craniofac Surg 2020; 32:193-197. [DOI: 10.1097/scs.0000000000007192] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Long-term Effect of Cranioplasty on Overlying Scalp Atrophy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3031. [PMID: 32983786 PMCID: PMC7489738 DOI: 10.1097/gox.0000000000003031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022]
Abstract
Scalp thinning over a cranioplasty can lead to complex wound problems, such as extrusion and infection. However, the details of this process remain unknown. The aim of this study was to describe long-term soft-tissue changes over various cranioplasty materials and to examine risk factors associated with accelerated scalp thinning.
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Alkhaibary A, Alharbi A, Alnefaie N, Oqalaa Almubarak A, Aloraidi A, Khairy S. Cranioplasty: A Comprehensive Review of the History, Materials, Surgical Aspects, and Complications. World Neurosurg 2020; 139:445-452. [PMID: 32387405 DOI: 10.1016/j.wneu.2020.04.211] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
Cranioplasty is a common neurosurgical procedure performed to reconstruct cranial defects. The materials used to replace bone defects have evolved throughout history. Cranioplasty materials can be broadly divided into biological and synthetic materials. Biological materials can be further subdivided into autologous grafts, allografts, and xenografts. Allografts (bony materials and cartilage from cadavers) and xenografts (bony materials from animals) are out of favor for use in cranioplasty because of their high rates of infection, resorption, and rejection. In autologous cranioplasty, either the cranial bone itself or bones from other parts of the body of the patient are used. Synthetic bone grafts have reduced the operation time and led to better cosmetic results because of the advancement of computer-based customization and three-dimensional printing. Aluminum was the first synthetic bone graft material used, but it was found to irritate neural tissue, induce seizures, and dissolve over time. Acrylic, in the form of methyl methacrylate, is the most widely used material in cranioplasty. Hydroxyapatite is a natural component of bone and is believed to enhance bone repair, resulting in decreased tissue reactions and promoting good osteointegration. Polyetheretherketones are light and nonconductive and do not interfere with imaging modalities. The complication rates of cranioplasty are high, and surgical site infection is the most common complication. The effect of cranioplasty timing on cognitive function remains debatable. However, the timing of cranioplasty is independent of neurologic outcomes. In this article, the history, materials, complications, and evolution of current practices used in cranioplasty are comprehensively reviewed.
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Affiliation(s)
- Ali Alkhaibary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | - Ahoud Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nada Alnefaie
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Ahmed Aloraidi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Sami Khairy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
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Binhammer A, Jakubowski J, Antonyshyn O, Binhammer P. Comparative Cost-Effectiveness of Cranioplasty Implants. Plast Surg (Oakv) 2020; 28:29-39. [PMID: 32110643 DOI: 10.1177/2292550319880922] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose The aim of this study was to compare operative duration and total hospital costs incurred for patients undergoing elective cranioplasty with a variety of materials, including manually shaped autogenous bone graft and titanium mesh, custom patient-specific titanium mesh, polymethyl methacrylate (PMMA) acrylic, and polyetheretherketone (PEEK) implants. Methods A single-centre retrospective chart review was used. Patient demographics, defect characteristics, total operative time, and length of hospital stay were obtained. Total costs were sourced from Sunnybrook and standardized to the 2014 to 2015 year. Bivariate and age-controlled multivariate analyses were performed with (n = 119) and without (n = 101) outliers. Results When outliers were removed, an age-controlled analysis revealed that autogenous implants resulted in an operative time of 178 ± 37 minutes longer than manually shaped titanium implants (P < .01). The average cost of cranioplasty was CAD$18 335 ± CAD$10 265 for manually shaped titanium implants, CAD$31 956 ± CAD$31 206 for custom patient-specific titanium implants, CAD$20 786 ± CAD$13 075 for PMMA, CAD$14 291 ± CAD$5562 for autogenous implants, and CAD$27 379 ± CAD$4945 for PEEK implants (P = .013). When outliers were removed, cranioplasty with PMMA and PEEK incurred greater costs, CAD$4442 ± CAD$2100 and CAD$13 372 ± CAD$2728, respectively, more than manually shaped titanium implants (P < .01). Conclusions Manually shaped titanium mesh is the most cost-effective implant choice for small cranial defects. Large unknown defects and frontal paranasal sinus defects are most effectively treated with autogenous bone or titanium mesh. Despite prolonged operative duration and inpatient admission, total costs were not significantly increased. Both PMMA and PEEK implants were significantly more costly, which may be a result of higher complications necessitating reoperation.
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Affiliation(s)
- Adam Binhammer
- Department of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Josie Jakubowski
- Department of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Oleh Antonyshyn
- Department of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Paul Binhammer
- Department of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada
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33
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Mahato A, Sandy Z, Bysakh S, Hupa L, Das I, Bhattacharjee P, Kundu B, De G, Nandi SK, Vallittu P, Balla VK, Bhattacharya M. Development of nano-porous hydroxyapatite coated e-glass for potential bone-tissue engineering application: An in vitro approach. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 111:110764. [PMID: 32279774 DOI: 10.1016/j.msec.2020.110764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 01/29/2023]
Abstract
To reconstruct the defects caused by craniectomies autologous, bone grafting was usually used, but they failed most commonly due to bone resorption, infections and donor-site morbidity. In the present investigation, an effort has been made for the first time to check the feasibility and advantage of using hydroxyapatite (HAp) coated e-glass as component of bone implants. Sol-gel synthesized coatings were found to be purely hydroxyapatite from XRD with graded and interconnected pores all over the surface observable in TEM. The interconnected porous nature of ceramics are found to increase bioactivity by acting to up-regulate the process of osseointegration through enhanced nutrient transfer and induction of angiogenesis. From TEM studies and nano indentation studies, we have shown that pores were considered to be appropriate for nutrient supply without compromising the strength of sample while in contact with physiological fluid. After SBF immersion test, porous surface was found to be useful for nucleation of apatite crystals, hence increasing the feasibility and bioactivity of sample. However, our quasi-dynamic study showed less crystallization but had significant formation of apatite layer. Overall, the in vitro analyses show that HAp coated e-glass leads to significant improvement of implant properties in terms of biocompatibility, cell viability and proliferation, osteoinductivity and osteoconductivity. HAp coating of e-glass can potentially be utilized in fabricating durable and strong bioactive non-metallic implants and tissue engineering scaffolds.
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Affiliation(s)
- Arnab Mahato
- CSIR-Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata, India
| | - Zhang Sandy
- Process Chemistry Centre, ÅboAkademi University, Finland
| | - Sandip Bysakh
- CSIR-Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata, India
| | - Leena Hupa
- Process Chemistry Centre, ÅboAkademi University, Finland
| | - Indranee Das
- CSIR-Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata, India
| | | | - Biswanath Kundu
- CSIR-Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata, India.
| | - Goutam De
- CSIR-Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata, India
| | - Samit K Nandi
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences (WBUAFS), Kolkata, India
| | - Pekka Vallittu
- Institute of Dentistry and Turku Clinical Biomaterials Centre - TCBC, University of Turku, Turku, Finland
| | - Vamsi K Balla
- CSIR-Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata, India
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Iaccarino C, Kolias AG, Roumy LG, Fountas K, Adeleye AO. Cranioplasty Following Decompressive Craniectomy. Front Neurol 2020; 10:1357. [PMID: 32063880 PMCID: PMC7000464 DOI: 10.3389/fneur.2019.01357] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic.
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Affiliation(s)
- Corrado Iaccarino
- Neurosurgery Unit, University Hospital of Parma, Parma, Italy.,Emergency Neurosurgery Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelos G Kolias
- Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Louis-Georges Roumy
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
| | - Kostas Fountas
- Department of Neurosurgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Amos Olufemi Adeleye
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Division of Neurological Surgery, Department of Surgery, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
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Ray AC, Philandrianos C, Bertrand B, Mélot A, Roche PH, Jaloux C, Casanova D. Two-stage free flap reconstruction of the scalp and calvaria for large neurosurgical resections. Microsurgery 2019; 40:331-336. [PMID: 31777989 DOI: 10.1002/micr.30538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 09/12/2019] [Accepted: 11/08/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Free tissue transfer is occasionally necessary during reconstruction of large scalp and calvarial bone resections. A single-stage procedure is usually performed but if a flap becomes necrotic it exposes brain tissue or the meninges. Performing a two-stage procedure, the surgeon must preserve flap vitality and manage flap complications before resecting a tumor, and therefore before exposing the brain or meninges. We report here the first series of two-stage free-flap reconstruction during major neurosurgical resection. METHODS From 2012 to 2018, nine free-flaps were performed to eight patients (61 years-old, on average). Average skull resection was 10.1 cm × 15 cm (range 6-18 cm × 9-24 cm). It was performed in all cases due to large malignant tumors. Resection/reconstruction was performed in all case in a two-step procedure: during the first step, the free-flap was harvested and anastomosed to the cranial site; during the second step, resection was performed and the flap was positioned into the defect to assure coverage. RESULTS Average flap size was 11.3 cm × 17.7 cm (range: 7-20 cm × 11-30 cm). Two flap complications occurred after the first stage and one flap did not survive. One patient died before the second stage. Seven patients had the second procedure; no flap complication occurred. All procedures ended in complete wound healing. Follow-up period was 41.5 months on average (range: 10-83 months). Final outcome was total remission for two patients, recurrence for four patients, and two patients died. CONCLUSIONS Our data suggest that the two-stage free-flap reconstruction may be employed for major scalp and calvaria resection.
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Affiliation(s)
- Anne-Claire Ray
- APHM, Plastic Department, Conception University Hospital, Marseille, France
| | | | - Baptiste Bertrand
- APHM, Plastic Department, Conception University Hospital, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Anthony Mélot
- APHM, Neurosurgery Department, North University Hospital, chemin des Bourrely, Marseille, France
| | - Pierre-Hugues Roche
- Aix-Marseille University, Marseille, France.,APHM, Neurosurgery Department, North University Hospital, chemin des Bourrely, Marseille, France
| | - Charlotte Jaloux
- APHM, Plastic Department, Conception University Hospital, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Dominique Casanova
- APHM, Plastic Department, Conception University Hospital, Marseille, France.,Aix-Marseille University, Marseille, France
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Chirurgie secondaire des craniosténoses et faciocraniosténoses. ANN CHIR PLAST ESTH 2019; 64:494-505. [DOI: 10.1016/j.anplas.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 12/22/2022]
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Split Calvarial Grafting for Closure of Large Cranial Defects: The Ideal Option? J Maxillofac Oral Surg 2019; 18:518-530. [PMID: 31624429 DOI: 10.1007/s12663-019-01198-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/02/2019] [Indexed: 10/27/2022] Open
Abstract
Among the various cranioplasty options for reconstruction of large post-craniectomy defects, split calvarial grafting offers numerous significant advantages such as the provision of viable autogenous bone graft material comprising of living, immunocompatible bony cells that integrate fully with the skull bone bordering the cranial defect. Its potential for revascularization and subsequent integration and consolidation allows its successful use even in previously infected or otherwise compromised recipient sites. Its excellent contour match at the recipient site and low cost as compared to various alloplastic implant materials often makes it preferable to the latter. Surgeon's skill, dexterity, expertise and experience are important factors to be considered in this highly technique-sensitive procedure.
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Demineralized Bone Matrix and Resorbable Mesh Bilaminate Cranioplasty Is Ineffective for Secondary Reconstruction of Large Pediatric Cranial Defects. Plast Reconstr Surg 2019; 145:137e-141e. [PMID: 31592945 DOI: 10.1097/prs.0000000000006386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Replacement of the autologous bone flap after decompressive craniectomy can be complicated by significant osteolysis or infection with large defects over scarred dura. Demineralized bone matrix is an alternative to autologous reconstruction, effective when reconstructing large defects using a resorbable mesh bilaminate technique in primary cranioplasty, but this technique has not been studied for revision cranioplasty and the setting of scarred dura. Retrospective review was performed of patients receiving demineralized bone matrix and resorbable mesh bilaminate cranioplasty for postdecompressive craniectomy defects. Seven patients (mean age, 4.2 years) were identified with a mean follow-up of 4.0 years. Computed tomography before the demineralized bone matrix and resorbable mesh bilaminate cranioplasty and at least 1 year postoperatively were compared. Defects were characterized and need for revision was assessed. All patients had craniectomy with associated hemidural scarring. Five patients had autologous bone flap cranioplasty associated with nearly total osteolysis, and two patients had deferral of bone flap before demineralized bone matrix and resorbable mesh bilaminate cranioplasty. Demineralized bone matrix and resorbable mesh bilaminate cranioplasty demonstrated unpredictable and poor ossification, with bony coverage unchanged at postoperative follow-up. All patients required major revision cranioplasty at a mean time of 2.5 years. Porous polyethylene was successfully used in six of the revisions, whereas exchange cranioplasty was used in the remaining patient, with a mean follow-up of 1.4 years. Although demineralized bone matrix and resorbable mesh bilaminate is appropriate for primary cranioplasty, it should be avoided in the setting of scarred or infected dura in favor of synthetic materials or exchange cranioplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
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Cranioplasty after craniectomy in pediatric patients-a systematic review. Childs Nerv Syst 2019; 35:1481-1490. [PMID: 30610476 DOI: 10.1007/s00381-018-4025-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Complications following cranioplasty with either autografts or cranial implants are commonly reported in pediatric patients. However, data regarding cranioplasty strategies, complications and long-term outcomes are not well described. This study systematically reviews the literature for an overview of current cranioplasty practice in children. METHODS A systematic review of articles published from inception to July 2018 was performed. Studies were included if they reported the specific use of cranioplasty materials following craniectomy in patients younger than 18 years of age, and had a minimum follow-up of at least 1 year. RESULTS Twenty-four manuscripts, describing a total of 864 cranioplasty procedures, met the inclusion criteria. The age of patients in this aggregate ranged from 1 month to 20 years and the weighted average was 8.0 years. The follow-up ranged from 0.4 months to 18 years and had a weighted average of 40.4 months. Autologous bone grafts were used in 484 cases (56.0%). Resorption, infection and/or hydrocephalus were the most frequently mentioned complications. In this aggregate group, 61 patients needed a revision cranioplasty. However, in 6/13 (46%) papers studying autologous cranioplasties, no data was provided on resorption, infection and revision cranioplasty rates. Cranial implants were used in 380 cases (44.0%), with custom-made porous hydroxyapatite being the most commonly used material (100/380, 26.3%). Infection and migration/fracturing/loosening were the most frequently documented complications. Eleven revision cranioplasties were reported. Again, no data was reported on infection and revision cranioplasty rates, in 7/16 (44%) and 9/16 (56%) of papers, respectively. CONCLUSION Our systematic review illuminates that whether autografts or cranial implants are used, postcranioplasty complications are quite common. Beyond this, the existing literature does not contain well documented and comparable outcome parameters, suggesting that prospective, long-term multicenter cohort studies are needed to be able to optimize cranioplasty strategies in children who will undergo cranioplasty following craniectomy.
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Zhang J, Tian W, Chen J, Yu J, Zhang J, Chen J. The application of polyetheretherketone (PEEK) implants in cranioplasty. Brain Res Bull 2019; 153:143-149. [PMID: 31425730 DOI: 10.1016/j.brainresbull.2019.08.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/19/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023]
Abstract
Cranioplasty is a challenge to neurosurgeons, especially considering protection of intracranial contents. In recent years, material choice for cranioplasty is still controversial, which brings complexity to this seemingly straightforward procedure. PEEK, a tough, rigid, biocompatible material, has been used more recently in cranioplasty to provide better protection. The aim of this review is to summarize the outcome of research conducted on the material for cranioplasty applications. We also reviewed the comparison of PEEK with several common materials in previous articles. This is also the most complete data review article at present. In addition, the combination of nano-materials and PEEK is also a hotspot of research, so we have made a careful review of this aspect. We also summarized our own experience, telling about the future prospects of PEEK in the field of clinical cranioplasty should be highlighted. Improving the bioactivity, porosity, thinning, biocompatibility, antibacterial ability, integration and cost reduction of PEEK implants without affecting their mechanical properties is a major challenge.
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Affiliation(s)
- Jibo Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Weiqun Tian
- Department of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, China
| | - Jiayi Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jin Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Chen Y, Zhang L, Qin T, Wang Z, Li Y, Gu B. Evaluation of neurosurgical implant infection rates and associated pathogens: evidence from 1118 postoperative infections. Neurosurg Focus 2019; 47:E6. [DOI: 10.3171/2019.5.focus18582] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 05/22/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVEVarious implanted materials are used in neurosurgery; however, there remains a lack of pooled data on infection rates (IRs) and infective bacteria over past decades. The goal of this study was to investigate implant infections in neurosurgical procedures in a longitudinal retrospective study and to evaluate the IRs of neurosurgically implanted materials and the distribution of pathogenic microorganisms.METHODSA systematic literature search was conducted using PubMed and Web of Science databases for the time period between 1968 and 2018. Neurosurgical implant infections were studied in 5 subgroups, including operations or diseases, implanted materials, bacteria, distribution by country, and time periods, which were obtained from the literature and statistically analyzed. In this meta-analysis, statistical heterogeneity across studies was tested by using p values and I2 values between studies of associated pathogens. Egger’s test was used for assessing symmetries of funnel plots with Stata 11.0 software. Methodological quality was assessed to judge the risk of bias according to the Cochrane Handbook.RESULTSA total of 22,971 patients from 227 articles satisfied the study’s eligibility criteria. Of these, 1118 cases of infection were reported, and the overall IR was 4.87%. In this study, the neurosurgical procedures or disorders with the top 3 IRs included craniotomy (IR 6.58%), cranioplasty (IR 5.89%), and motor movement disorders (IR 5.43%). Among 13 implanted materials, the implants with the top 3 IRs included polypropylene-polyester, titanium, and polyetheretherketone (PEEK), which were 8.11%, 8.15%, and 7.31%, respectively. Furthermore, the main causative pathogen was Staphylococcus aureus and the countries with the top 3 IRs were Denmark (IR 11.90%), Korea (IR 10.98%), and Mexico (IR 9.26%). Except for the low IR from 1998 to 2007, the overall implant IR after neurosurgical procedures was on the rise.CONCLUSIONSIn this study, the main pathogen in neurosurgery was S. aureus, which can provide a certain reference for the clinic. In addition, the IRs of polypropylene-polyester, titanium, and PEEK were higher than other materials, which means that more attention should be paid to them. In short, the total IR was high in neurosurgical implants and should be taken seriously.
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Affiliation(s)
- Ying Chen
- 1Department of Microbiology and Immunology, School of Medical Technology, Xuzhou Medical University; and
| | - Linyan Zhang
- 1Department of Microbiology and Immunology, School of Medical Technology, Xuzhou Medical University; and
| | - Tingting Qin
- 2Clinical Microbiology Laboratory, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhenzhen Wang
- 1Department of Microbiology and Immunology, School of Medical Technology, Xuzhou Medical University; and
| | - Ying Li
- 1Department of Microbiology and Immunology, School of Medical Technology, Xuzhou Medical University; and
| | - Bing Gu
- 1Department of Microbiology and Immunology, School of Medical Technology, Xuzhou Medical University; and
- 2Clinical Microbiology Laboratory, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Use of Vacuum-Assisted Wound Closure and Tissue Expansion in Revision Cranioplasty for a Large-Sized Composite Defect in a Child. J Craniofac Surg 2019; 30:838-840. [PMID: 30845080 DOI: 10.1097/scs.0000000000005181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cranioplasty is generally defined as the procedure to reconstruct cranial bone defect arising from congenital or acquired process. As a surgical remedy, it can restore the function of original anatomical structure and produce a satisfactory cosmetic outcome. Although with available options for treating pediatric cranioplasty, large format (ie, >25 cm) cranioplasty of the aborted one with a composite defect is still a challenging procedure for plastic surgeons. The authors herein present a case of child who suffered failed cranioplasty with polyetheretherketone caused by postoperative infection, leading to skin ulcer and exposure of the polyetheretherketone. The treatments of the patient are performed sequentially. After thorough debridement of the wound, vacuum-assisted wound closure and autologous split-thickness skins are successively used to cover the defect following finally adopted strategy of tissue expansion of the scalp with a 3-dimensional-printed epoxide acrylate maleic composite material to repair the large-sized cranial defect.
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Abstract
BACKGROUND Management of cranial osteomyelitis is challenging and often includes débridement of infected bone and delayed alloplastic cranioplasty. However, the optimal interval between the removal of infected bone and definitive reconstruction remains controversial. The authors investigated the optimal time for definitive reconstruction and factors influencing cranioplasty reinfection. METHODS A retrospective review of 111 alloplastic cranioplasties for osteomyelitis between 2002 and 2015 was performed. Patients were divided into four subgroups based on timing of reconstruction: group 1, less than 3 months; group 2, 3 to 6 months; group 3, 6 to 12 months; and group 4, more than 12 months. Multivariate logistic regression was used to calculate the probability of cranioplasty reinfection based on risk factors. Median follow-up was 45.9 months (range, 12.4 to 136.9 months). RESULTS The combined reinfection rate was 23.4 percent. The reinfection rate in group 1 was 39.6 percent; group 2, 12.5 percent; group 3, 8.0 percent; and group 4, 0.0 percent (p < 0.001). The mean interval between the infected bone removal and cranioplasty was shorter in patients with reinfection than in patients without reinfection (2.2 ± 3.9 months versus 6.1 ± 8.3 months; p < 0.001). The strongest independent predictors of reinfection were chemotherapy (OR, 10.1; 95 percent CI, 2.9 to 35.2), composite defect requiring scalp reconstruction at the time of cranioplasty (OR, 3.3; 95 percent CI, 1.2 to 8.9), and early reconstruction. Each month of delay in reconstruction reduced the reinfection rate by 10 percent (OR, 0.9 per each month of delay; 95 percent CI, 0.8 to 1.0). Cranioplasty material was not significant. CONCLUSIONS Early alloplastic cranioplasty following osteomyelitis carries an unacceptably high risk of reinfection. This risk decreases by 10 percent with each month of delay. The authors' regression model can be used to predict the probability of reinfection for all time periods. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Korhonen TK, Salokorpi N, Niinimäki J, Serlo W, Lehenkari P, Tetri S. Quantitative and qualitative analysis of bone flap resorption in patients undergoing cranioplasty after decompressive craniectomy. J Neurosurg 2019; 130:312-321. [PMID: 29473777 DOI: 10.3171/2017.8.jns171857] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/21/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE: Autologous bone cranioplasty after decompressive craniectomy entails a notable burden of difficult postoperative complications, such as infection and bone flap resorption (BFR), leading to mechanical failure. The prevalence and significance of asymptomatic BFR is currently unclear. The aim of this study was to radiologically monitor the long-term bone flap survival and bone quality change in patients undergoing autologous cranioplasty. METHODS: The authors identified all 45 patients who underwent autologous cranioplasty at Oulu University Hospital, Finland, between January 2004 and December 2014. Using perioperative and follow-up CT scans, the volumes and radiodensities of the intact bone flap prior to surgery and at follow-up were calculated. Relative changes in bone flap volume and radiodensity were then determined to assess cranioplasty survival. Sufficient CT scans were obtainable from 41 (91.1%) of the 45 patients. RESULTS: The 41 patients were followed up for a median duration of 3.79 years (25th and 75th percentiles = 1.55 and 6.66). Thirty-seven (90.2%) of the 41 patients had some degree of BFR and 13 (31.7%) had a remaining bone flap volume of less than 80%. Patients younger than 30 years of age had a mean decrease of 15.8% in bone flap volume compared with the rest of the cohort. Bone flap volume was not found to decrease linearly with the passing of time, however. The effects of lifestyle factors and comorbidities on BFR were nonsignificant. CONCLUSIONS: In this study BFR was a very common phenomenon, occurring at least to some degree in 90% of the patients. Decreases in bone volume were especially prominent in patients younger than 30 years of age. Because the progression of resorption during follow-up was nonlinear, routine follow-up CT scans appear unnecessary in monitoring the progression of BFR; instead, clinical follow-up with mechanical stability assessment is advised. Partial resorption is most likely a normal physiological phenomenon during the bone revitalization process.
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Affiliation(s)
| | | | | | - Willy Serlo
- 3PEDEGO Research Unit; and
- 5Department of Children and Adolescents, Oulu University Hospital, MRC Oulu, Finland
| | - Petri Lehenkari
- 4Department of Anatomy and Cell Biology, University of Oulu; and
| | - Sami Tetri
- 1Department of Neurosurgery, Oulu University Hospital
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Reconstruction of Secondary Calvarial Defects with Ex Situ Split Calvarial Bone Grafts. Plast Reconstr Surg 2019; 143:223-233. [DOI: 10.1097/prs.0000000000005129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Eles JR, Vazquez AL, Kozai TDY, Cui XT. Meningeal inflammatory response and fibrous tissue remodeling around intracortical implants: An in vivo two-photon imaging study. Biomaterials 2018; 195:111-123. [PMID: 30634095 DOI: 10.1016/j.biomaterials.2018.12.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/15/2018] [Accepted: 12/28/2018] [Indexed: 12/21/2022]
Abstract
Meningeal inflammation and encapsulation of neural electrode arrays is a leading cause of device failure, yet little is known about how it develops over time or what triggers it. This work characterizes the dynamic changes of meningeal inflammatory cells and collagen-I in order to understand the meningeal tissue response to neural electrode implantation. We use in vivo two-photon microscopy of CX3CR1-GFP mice over the first month after electrode implantation to quantify changes in inflammatory cell behavior as well as meningeal collagen-I remodeling. We define a migratory window during the first day after electrode implantation hallmarked by robust inflammatory cell migration along electrodes in the meninges as well as cell trafficking through meningeal venules. This migratory window attenuates by 2 days post-implant, but over the next month, the meningeal collagen-I remodels to conform to the surface of the electrode and thickens. This work shows that there are distinct time courses for initial meningeal inflammatory cell infiltration and meningeal collagen-I remodeling. This may indicate a therapeutic window early after implantation for modulation and mitigation of meningeal inflammation.
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Affiliation(s)
- J R Eles
- Bioengineering, University of Pittsburgh, United States; Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, United States
| | - A L Vazquez
- Bioengineering, University of Pittsburgh, United States; Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, United States; Radiology, University of Pittsburgh, United States
| | - T D Y Kozai
- Bioengineering, University of Pittsburgh, United States; Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, United States; NeuroTech Center of the University of Pittsburgh Brain Institute, United States; Center for Neuroscience, University of Pittsburgh, United States
| | - X T Cui
- Bioengineering, University of Pittsburgh, United States; Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, United States.
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Leão RDS, Maior JRS, Lemos CADA, Vasconcelos BCDE, Montes MAJR, Pellizzer EP, Moraes SLD. Complications with PMMA compared with other materials used in cranioplasty: a systematic review and meta-analysis. Braz Oral Res 2018; 32:e31. [PMID: 29898018 DOI: 10.1590/1807-3107bor-2018.vol32.0031] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/09/2018] [Indexed: 11/22/2022] Open
Abstract
Polymethyl methacrylate (PMMA) has been considered a suitable material for cranioplasty. However, no consensus has been reached concerning the best material for cranioplasty with regard to minimizing complications. Thus, this systematic review and meta-analysis aimed to compare the complication rates of PMMA with those of autologous bone and titanium mesh. This review was registered with PROSPERO (CRD42016042725). Systematic searches were conducted on PubMed/MEDLINE, Scopus, and Web of Science. The focus question was, "Do PMMA prostheses used in cranioplasty have complications rates similar to those of autologous bone and titanium mesh?" A meta-analysis of complication rates was performed on the basis of dichotomous outcomes assessed by risk ratio (RR) with corresponding 95% confidence intervals (CI). From 1014 data sources, 11 articles were selected according to eligibility criteria. These articles involved 1,256 individuals and 1,278 cranioplasties using autologous bone (n = 408), PMMA (n = 379), or titanium (n = 151). The follow-up period ranged from 63 days to 54.3 months. No difference was observed between the complication rates of PMMA and autologous bone (p = 0.94; RR, 0.98; 95%CI, 0.54-1.75) or between PMMA and titanium (p = 0.38; RR, 1.59; 95%CI, 0.57-4.48). Sub-analysis of the reasons for craniotomy (trauma/non-trauma) was conducted, which revealed no significant difference (p = 0.91; RR, 0.95; 95%CI, 0.37-2.42). The meta-analysis indicated that the use of PMMA yields complication rates that are near those of autologous bone and titanium mesh.
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Affiliation(s)
| | | | | | | | | | - Eduardo Piza Pellizzer
- Universidade de Pernambuco - UPE, Dentistry School, Programs in Oral and Maxillofacial Surgery, Recife, PE, Brazil
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