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Linkugel AD, Markiewicz MR, Edwards S, Susarla SM. Conceptual Principles in Pediatric Craniomaxillofacial Reconstruction. Oral Maxillofac Surg Clin North Am 2024; 36:411-424. [PMID: 38705817 DOI: 10.1016/j.coms.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Pediatric craniomaxillofacial reconstruction must be approached through the lens of growth and durability. A systematic approach of matching defects to donor tissue drives the selection of autologous reconstructive technique. The menu of available methods for reconstruction can be organized in a manner similar to adults, with special considerations for growth and development. Reconstructive surgeons have the opprtunity to promote and maintain young patients' sense of identity during psychosocial development.
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Affiliation(s)
- Andrew D Linkugel
- Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NorhtEast, Seattle, WA 98105, USA; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, University at Buffalo School of Dental Medicine, 3435 Main Street, 112 Squire Hall, Buffalo NY 14214, USA
| | - Sean Edwards
- Department of Oral & Maxillofacial Surgery, University of Michigan School of Dentistry, 2200 Vinewood Boulevard, Ann Arbor, MI 48104, USA
| | - Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NorhtEast, Seattle, WA 98105, USA; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA; Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA, USA.
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2
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Zheng E, Cherukuri S, Arpey CJ, Ahn ES, Mardini S, Gibreel W. Managing the positive periosteal margin after Mohs excision of scalp dermatofibrosarcoma protuberans in children with underlying calvarial bone thinning and resorption: The value of multidisciplinary treatment. JAAD Case Rep 2023; 39:26-29. [PMID: 37576953 PMCID: PMC10415635 DOI: 10.1016/j.jdcr.2023.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Affiliation(s)
- Eugene Zheng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sai Cherukuri
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Edward S. Ahn
- Division of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Samir Mardini
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Waleed Gibreel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
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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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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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Sulin KA, Ivanov VP, Kim AV, Khachatryan VA. [Skull defect repair in children using a 3D-printing technology]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:67-75. [PMID: 33306301 DOI: 10.17116/neiro20208406167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Currently, 3D-printing technologies are increasingly used in neurosurgery. Active development of this approach is valuable to improve preoperative planning, intraoperative navigation, and manufacturing of realistic training models. In this manuscript, the authors report an experience of the pediatric neurosurgical department of the Almazov National Medical Research Center regarding 3D-printing technologies in manufacturing of individual implants for skull defect closure. The main aspects of this technology, advantages and disadvantages are considered. Moreover, the authors describe several cases of creating individual implants for children with skull defects of various origins, dimensions and complexity.
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Affiliation(s)
- K A Sulin
- Almazov National Medical Research Center, Saint-Petersburg, Russia
| | - V P Ivanov
- Almazov National Medical Research Center, Saint-Petersburg, Russia
| | - A V Kim
- Almazov National Medical Research Center, Saint-Petersburg, Russia
| | - V A Khachatryan
- Almazov National Medical Research Center, Saint-Petersburg, Russia
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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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OssDsign cranioplasty in children: a single-centre experience. Childs Nerv Syst 2020; 36:1773-1776. [PMID: 32215714 DOI: 10.1007/s00381-020-04584-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION OssDsign have developed a new type of cranioplasty plate, consisting of calcium phosphate reinforced with titanium. Currently, there is little known about the cosmetic outcomes and infection rate when OssDsign cranioplasty plates are implanted into paediatric patients. METHODS A retrospective case series was performed to include all paediatric patients who received an OssDsign cranioplasty at a single centre, Sheffield Children's Hospital. The cosmetic outcomes were subjectively reported by the parents of the children. RESULTS We identified seven paediatric patients where OssDsign cranioplasty was performed. This included two bifrontal and five hemicranioplasties. However, there was failure to implant an OssDsign hemicranioplasty in one patient where a titanium plate was subsequently used. The median duration of follow-up was 15 months. The infection rate was zero. The parents of the patients who successfully received OssDsign cranioplasties were pleased with the cosmetic outcomes. There were cosmetic complaints from the parents of the one patient who received a titanium plate. CONCLUSION Our early experience with OssDsign cranioplasty in paediatric patients indicates that it may potentially be associated with a low rate of infection and good cosmetic outcomes.
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Exchange Cranioplasty Using Bioabsorbable Hydroxyapatite and Collagen Complex After Removal of an Extensive Frontal Bone Tumor in an Infant. World Neurosurg 2020; 142:375-378. [PMID: 32702496 DOI: 10.1016/j.wneu.2020.07.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Forehead reconstruction is challenging. Reconstruction of the innate curvature of the forehead is difficult, and the forehead is an esthetically important part of the face. Although synthetic implants and autologous split bone grafts are useful, these cannot be used in infants. CASE DESCRIPTION A 4-month-old girl was presented with a right frontal bone Ewing sarcoma. The tumor was removed, and the defect was reconstructed with an autologous contralateral parietal bone graft. The parietal bone defect was repaired with a bioabsorbable hydroxyapatite and collagen complex. Good reconstruction of the forehead and ossification of the donor site was achieved within 3 years after surgery. CONCLUSIONS After removal of an extensive frontal bone tumor in an infant, exchange cranioplasty with an autograft using a bioabsorbable hydroxyapatite and collagen complex at the donor site yielded good results.
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Free Flap Reconstruction of Complex Oncologic Scalp Defects in the Setting of Mesh Cranioplasty. J Craniofac Surg 2020; 31:1107-1110. [DOI: 10.1097/scs.0000000000006421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Computer-Aided-Design/Computer-Aided-Manufacturing Titanium Cranioplasty in a Child: Critical Appraisal. J Craniofac Surg 2019; 31:237-240. [PMID: 31714337 DOI: 10.1097/scs.0000000000005948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Large skull bone defects of the cranial vault can result from various reasons. Reconstruction of these defects is performed for protective and aesthetic reasons but is also required for adequate intracranial homeostasis. Computer-aided-design/computer-aided-manufacturing (CAD/CAM) patient-specific skull implants have become the most valuable alternative to the traditional methods of reconstruction and a growing number of publications is dealing with this topic in adults. Literature related to the application of these implants in pediatric cranioplasty is, however, still scarce.The authors present a case of a 9-year-old boy, where cranioplasty using a CAD/CAM additive manufactured titanium implant led to improvement of symptoms attributed to cerebrospinal fluid circulation problems and intracranial homeostasis disbalance. The authors further reflect on what the role of cranioplasty should be in the therapeutic treatment plan.
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Rosinski CL, Patel S, Geever B, Chiu RG, Chaker AN, Zakrzewski J, Rosenberg DM, Parola R, Shah K, Behbahani M, Mehta AI. A Retrospective Comparative Analysis of Titanium Mesh and Custom Implants for Cranioplasty. Neurosurgery 2019; 86:E15-E22. [DOI: 10.1093/neuros/nyz358] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/02/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractBACKGROUNDAutologous bone removed during craniectomy is often the material of choice in cranioplasty procedures. However, when the patient's own bone is not appropriate (infection and resorption), an alloplastic graft must be utilized. Common options include titanium mesh and polyetheretherketone (PEEK)-based custom flaps. Often, neurosurgeons must decide whether to use a titanium or custom implant, with limited direction from the literature.OBJECTIVETo compare surgical outcomes of synthetic cranioplasties performed with titanium or vs custom implants.METHODSTen-year retrospective comparison of patients undergoing synthetic cranioplasty with titanium or custom implants.RESULTSA total of 82 patients were identified for review, 61 (74.4%) receiving titanium cranioplasty and 21 (25.6%) receiving custom implants. Baseline demographics and comorbidities of the 2 groups did not differ significantly, although multiple surgical characteristics did (size of defect, indication for craniotomy) and were controlled for via a 2:1 mesh-to-custom propensity matching scheme in which 36 titanium cranioplasty patients were compared to 18 custom implant patients. The cranioplasty infection rate of the custom group (27.8%) was significantly greater (P = .005) than that of the titanium group (0.0%). None of the other differences in measured complications reached significance. Discomfort, a common cause of reoperation in the titanium group, did not result in reoperation in any of the patients receiving custom implants.CONCLUSIONInfection rates are higher among patients receiving custom implants compared to those receiving titanium meshes. The latter should be informed of potential postsurgical discomfort, which can be managed nonsurgically and is not associated with return to the operating room.
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Affiliation(s)
- Clayton L Rosinski
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
| | - Saavan Patel
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
| | - Brett Geever
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
| | - Ryan G Chiu
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
| | - Anisse N Chaker
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
| | - Jack Zakrzewski
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
| | - David M Rosenberg
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
| | - Rown Parola
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
| | - Koral Shah
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
| | - Mandana Behbahani
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
| | - Ankit I Mehta
- Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois
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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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Cranioplasties following craniectomies in children-a multicenter, retrospective cohort study. Childs Nerv Syst 2019; 35:1473-1480. [PMID: 30554262 DOI: 10.1007/s00381-018-4024-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Complications following pediatric cranioplasty after craniectomy with either autologous bone flaps or cranial implants are reported to be common, particularly bone flap resorption. However, only sparse data are available regarding cranioplasty strategies, complications, and outcomes. This manuscript describes a Canadian-Dutch multicenter pediatric cohort study with autografts and cranial implant cranioplasties following craniectomies for a variety of indications. METHODS The study included all children (< 18 years) who underwent craniectomy and subsequent cranioplasty surgeries from 2008 to 2014 (with a minimum of 1-year follow-up) at four academic hospitals with a dedicated pediatric neurosurgical service. Data were collected regarding initial diagnosis, age, time interval between craniectomy and cranioplasty, bone flap storage method, type of cranioplasty for initial procedure (and redo if applicable), and the postoperative outcome including surgical site infection, wound breakdowns, bone flap resorption, and inadequate fit/disfigurement. RESULTS Sixty-four patients (46 males, average age 9.7 ± 5.5 years) were eligible for inclusion, with mean follow-up of 82.3 ± 31.2 months after craniectomy. Forty cranioplasties (62.5%) used autologous bone re-implant, 23 (57.5%) of which showed resorption. On average, resorption was documented at 434 days (range 62-2796 days) after reimplantation. In 20 cases, a revision cranioplasty was needed. In 24 of the post-craniectomy cases (37.5%), a cranial implant was used with one of ten different implant types. Implant loosening prompted a complete revision cranioplasty in 2 cases (8.3%). Cranial implants were associated with low morbidity and lower reoperation dates compared to the autologous cranioplasties. CONCLUSION The most prominent finding in this multicenter cohort study was that bone flap resorption in children remains a common and widespread problem following craniectomy. Cranioplasty strategies varied between centers and evolved over time within centers. Cranial implants were associated with low morbidity and low reoperation rates. Still, longer term and prospective multicenter cohort studies are needed to optimize cranioplasty strategies in children after craniectomies.
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Discussion: Outcomes and Complications of Pediatric Cranioplasty: A Systematic Review. Plast Reconstr Surg 2019; 144:444e-445e. [PMID: 31461030 DOI: 10.1097/prs.0000000000005994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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17
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Abstract
Craniofacial surgeons are often confronted with major defects of the calvarium. These most commonly are post-traumatic but could also be consequent upon neurosurgical procedures, infection, or tumor removal. There are several options available to reconstruct these defects including autogenous, heterogeneous, and alloplastic material. The goal is to have a method that is easy, cost-effective, with minimal complications, and long-lasting. In our unit we review 100 cases of the use of stock titanium mesh during a 5-year period. Complications occurred in 5 patients (5%) with 3 exposures, 1 late seroma and 1 case requiring repositioning of the plate following trauma. None of the patients required removal of the plate.
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18
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Sharaf B, Asaad M, Banuelos J, Meaike J. Deformation of cranioplasty titanium mesh in a paediatric patient following head trauma. BMJ Case Rep 2019; 12:12/6/e230421. [PMID: 31189547 DOI: 10.1136/bcr-2019-230421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Decompressive craniectomy is a life-saving procedure performed to treat intracranial hypertension caused by a variety of conditions. Subsequent cranioplasty reconstruction is needed for brain protection. Different alloplastic materials with different advantages and disadvantages are available for cranial reconstruction. We present the first case of a deformed titanium cranioplasty mesh in a paediatric patient following head trauma. Children who have undergone cranioplasty reconstruction should be counselled to wear a protective helmet when involved in contact sports or activities that may put their implant at risk of trauma.
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Affiliation(s)
- Basel Sharaf
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Malke Asaad
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph Banuelos
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jesse Meaike
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
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19
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Sheng HS, Shen F, Zhang N, Lin FC, Li DD, Cai M, Jiang GQ, Lin J. Titanium mesh cranioplasty in pediatric patients after decompressive craniectomy: Appropriate timing for pre-schoolers and early school age children. J Craniomaxillofac Surg 2019; 47:1096-1103. [PMID: 31088762 DOI: 10.1016/j.jcms.2019.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/12/2019] [Accepted: 04/16/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE There is little knowledge on the growth of cranial defects, appropriate timing and outcomes of application of titanium mesh for cranioplasty in the pediatric population, especially pre-school age (2-5 years old) and school age (6-12 years old) children. We hypothesised that cranioplasty for pre-schoolers could be delayed to school age due to the expected cranium growth, whereas, for the school age group, it is better to perform routine cranioplasty (3-6 months) to protect the brain and therefore ensure their timely return to school life. MATERIALS AND METHODS A retrospective review of pediatric patients (2-12 years old) who underwent titanium mesh cranioplasty for cranial defects from 2006 to 2012 was performed. Patient demographic data, radiological data, and clinical information were collected. Specifically, cranial defect sizes were evaluated by three-dimensional (3D) reconstruction of computed tomography data after craniectomy, before cranioplasty and 2-years after cranioplasty. Patients were routinely followed up at an outpatient clinic for complications and school attendance. RESULTS A total of 18 titanium mesh cranioplasties were performed in 18 patients. The average interval between craniectomy and cranioplasty was 3 years for pre-schoolers and 4 months for the school age group. Patients in the pre-schooler group showed significant enlargements in cranial defects during the interval as compared with the school age group (26% vs. 4%, P < 0.05). There were no surgery-related complications except in one patient, who had titanium mesh exposure 11 months later. Two years after cranioplasty, there was no significant difference in mild cranial defect enlargements between the two groups (11% vs. 6%, P > 0.05). Patients were followed for an average of 5 (range, 2-8) years. All patients had satisfactory recovery of cranial contour, sufficient protection of the brain and active participation in school study. All patients had satisfactory recovery of cranial contour, sufficient protection of the brain and active participation in school. CONCLUSION Timing of titanium mesh cranioplasty after decompressive craniectomy based on their age is a workable solution for school-age pediatric patients. The enlargement of cranium defects in pre-schoolers supports a delayed repair until school age. The long-term outcomes for these patients with titanium mesh cranioplasty are favourable.
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Affiliation(s)
- Han-Song Sheng
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Fang Shen
- Department of Orthopaedic Surgery's Spine Division, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang, China.
| | - Nu Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Fen-Chun Lin
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Dan-Dong Li
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Ming Cai
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Guo-Qiang Jiang
- Department of Orthopaedic Surgery's Spine Division, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang, China.
| | - Jian Lin
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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20
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Abstract
Historically, the approach to pediatric cranioplasty has been largely extrapolated from the treatment of adults. More recently, however, the intricacies of pediatric cranial reconstruction have become better understood, and the surgical management has been refined contemporaneously. Each patient's cranial defect bears a unique set of challenges and, as such, the choice of cranioplasty technique must be tailored accordingly.
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Affiliation(s)
- Michael R Bykowski
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 664 Scaife Hall, Pittsburgh, PA 15261, USA
| | - Jesse A Goldstein
- Department of Plastic Surgery, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion, Floor 7, Pittsburgh, PA 15224, USA
| | - Joseph E Losee
- Department of Plastic Surgery, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion, Floor 7, Pittsburgh, PA 15224, USA.
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21
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Urhie O, Radwan W, Lucke-Wold B, Chin TJ, Serrano C. PEEK Implant: A Case Report Illustrating the Benefits for Correcting Craniosynostosis Asymmetry. ACTA SCIENTIFIC NEUROLOGY 2018; 1:13-16. [PMID: 30899918 DOI: pmid/30899918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Unilateral coronal synostosis can cause aesthetically unappealing plagiocephaly, which often requires surgical correction. The techniques utilized for this operation have continued to evolve. Unfortunately, some patients who have fronto-orbital advancement will have residual asymmetry. CASE We present a case of a 21 year-old female with residual asymmetry who was suffering from facial swelling and refractory trigeminal neuralgia. It was decided to perform an additional surgery with polytheretheketone (PEEK) implant to restore normal symmetry and provide symptomatic relief. CONCLUSION The ideal fit PEEK implant provided excellent cosmetic results and the operation relieved her symptoms. We provide a detailed discussion on why PEEK implants are great options for these types of cases due to advanced pre-surgical planning technology, ease of placement, and durability over time.
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Affiliation(s)
- Ogaga Urhie
- Department of Neurosurgery, West Virginia University, Morgantown, USA
| | - Walid Radwan
- Department of Neurosurgery, West Virginia University, Morgantown, USA
| | | | - T J Chin
- Department of Neurosurgery, West Virginia University, Morgantown, USA
| | - Cesar Serrano
- Department of Neurosurgery, West Virginia University, Morgantown, USA
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