1
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Peng YN, Liu ZZ, Qiao L. The Applicability of Polyetheretherketone and Titanium Mesh in Cranioplasty: A Retrospective Comparative Analysis. J Craniofac Surg 2024:00001665-990000000-01735. [PMID: 38949256 DOI: 10.1097/scs.0000000000010432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
OBJECTIVE To compare the clinical application effect and safety of polyetheretherketone (PEEK) and titanium mesh (TM) in cranioplasty. METHODS Four-year retrospective comparison of patients (96 cases) undergoing synthetic cranioplasty with PEEK or TM. The patients were divided into the PEEK group (24 cases) and the TM group (72 cases) according to the implants, and the patient demographics, general conditions before the operation, postoperative complications, length of postoperative hospital stay, total costs, satisfaction with shaping and long-term complications were compared between the 2 groups. RESULTS Patients in the PEEK group were younger than those in the TM group (P=0.019). Hospitalization costs were significantly higher in the PEEK group than in the TM group (P<0.001). The incidence of postoperative subcutaneous effusion was 33% in the PEEK group and 6.9% in the TM group, which suggests that patients in the PEEK group had a higher risk of postoperative subcutaneous effusion (P=0.001). There was no significant difference in the incidence of long-term complications and cosmetic satisfaction between the 2 groups at 4 years postoperatively. CONCLUSIONS In this study, both titanium mesh and PEEK are reliable implants for cranioplasty. Titanium mesh is widely used in cranioplasty due to its cost-effective performance. PEEK has gradually gained recognition due to the characteristics of the material and surgical procedure, but the price needs to be further reduced, and attention should be paid to the occurrence and treatment of early postoperative subcutaneous effusion.
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Affiliation(s)
- Yao-Nan Peng
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhen-Zhen Liu
- Department of Rehabilitation Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Liang Qiao
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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2
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Todaro M, Saponaro G, Perquoti F, Gasparini G, Signorelli F, Tartaglione T, Moro A. Bone Regeneration and Polyetheretherketone Implants in Maxillo-Facial Surgery and Neurosurgery: A Multidisciplinary Study. BIOLOGY 2024; 13:467. [PMID: 39056662 PMCID: PMC11273635 DOI: 10.3390/biology13070467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/12/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
Polyetheretherketone (PEEK) in the last few years has emerged as an exceedingly promising material for craniofacial defects due to its biocompatibility and mechanical properties. However, its utilization remains controversial due to its inertness and low osteoinductivity. This study aimed to investigate the postoperative outcomes of patients undergoing maxillo-facial and neurosurgical procedures with PEEK implants. The focus is on evaluating bone regrowth on the surface and edges of the implant, periosteal reactions, and implant positioning. A retrospective analysis of 12 maxillo-facial surgery patients and 10 neurosurgery patients who received PEEK implants was conducted. CT scans performed at least one year post operation were examined for bone regrowth, periosteal reactions, and implant positioning. In maxillo-facial cases, the analysis included mandibular angle and fronto-orbital reconstruction, while neurosurgical cases involved cranioplasty. In maxillofacial surgery, 11 out of 12 patients showed radiological evidence of bone regrowth around PEEK implants, with favorable outcomes observed in craniofacial reconstruction. In neurosurgery, 9 out of 10 patients exhibited minimal or none bone regrowth, while one case demonstrated notable bone regeneration beneath the PEEK implant interface. The study highlights the importance of implant design and patient-specific factors in achieving successful outcomes, providing valuable insights for future implant-based procedures.
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Affiliation(s)
- Mattia Todaro
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (F.P.); (G.G.); (A.M.)
| | - Gianmarco Saponaro
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (F.P.); (G.G.); (A.M.)
| | - Federico Perquoti
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (F.P.); (G.G.); (A.M.)
| | - Giulio Gasparini
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (F.P.); (G.G.); (A.M.)
| | - Francesco Signorelli
- Neurosurgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy;
| | - Tommaso Tartaglione
- Radiology Department, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy;
| | - Alessandro Moro
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (F.P.); (G.G.); (A.M.)
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3
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Iratwar S, Roy Chowdhury S, Pisulkar S, Das S, Agarwal A, Bagde A, Paikrao B, Quazi S, Basu B. Comprehensive functional outcome analysis and importance of bone remodelling on personalized cranioplasty treatment using Poly(methyl methacrylate) bone flaps. J Biomater Appl 2024; 38:975-988. [PMID: 38423069 DOI: 10.1177/08853282241235884] [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: 03/02/2024]
Abstract
Cranioplasty involves the surgical reconstruction of cranial defects arising as a result of various factors, including decompressive craniectomy, cranial malformations, and brain injury due to road traffic accidents. Most of the modern decompressive craniectomies (DC) warrant a future cranioplasty surgery within 6-36 months. The conventional process of capturing the defect impression and polymethyl methacrylate (PMMA) flap fabrication results in a misfit or misalignment at the site of implantation. Equally, the intra-operative graft preparation is arduous and can result in a longer surgical time, which may compromise the functional and aesthetic outcomes. As part of a multicentric pilot clinical study, we recently conducted a cohort study on ten human subjects during 2019-2022, following the human ethics committee approvals from the participating institutes. In the current study, an important aspect of measuring the extent of bone remodelling during the time gap between decompressive craniectomy and cranioplasty was successfully evaluated. The sterilised PMMA bone flaps were implanted at the defect area during the cranioplasty surgery using titanium mini plates and screws. The mean surgery time was 90 ± 20 min, comparable to the other clinical studies on cranioplasty. No signs of intra-operative and post-operative complications, such as cerebrospinal fluid leakage, hematoma, or local and systemic infection, were clinically recorded. Importantly, aesthetic outcomes were excellent for all the patients, except in a few clinical cases, wherein the PMMA bone flap was to be carefully customized due to the remodelling of the native skull bone. The extent of physiological remodelling was evaluated by superimposing the pre-operative and post-operative CT scan data after converting the defect morphology into a 3D model. This study further establishes the safety and efficacy of a technologically better approach to fabricate patient-specific acrylic bone flaps with improved surgical outcomes. More importantly, the study outcome further demonstrates the strategy to address bone remodelling during the patient-specific implant design.
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Affiliation(s)
- Sandeep Iratwar
- Department of Neurosurgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | | | - Shweta Pisulkar
- Department of Prosthodontics, Crown & Bridge, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | - Soumitra Das
- Material Research Centre, Indian Institute of Science, Bangalore, India
| | - Akhilesh Agarwal
- Bio-Innovation cell, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | - Ashutosh Bagde
- Faculty of Engineering Technology, Biomedical Engineering/and Research Scientist, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | - Balaji Paikrao
- Department of Mechanical Engineering, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Syed Quazi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, India
| | - Bikramjit Basu
- Material Research Centre, Indian Institute of Science, Bangalore, India
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4
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Mannella FC, Faedo F, Fumagalli M, Norata GD, Zaed I, Servadei F. Long-Term Follow-Up of Custom-Made Porous Hydroxyapatite Cranioplasties: Analysis of Infections in Adult and Pediatric Patients. J Clin Med 2024; 13:1133. [PMID: 38398446 PMCID: PMC10888657 DOI: 10.3390/jcm13041133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
In neurosurgery, cranioplasty (CP) stands as a pivotal surgical intervention, particularly following head trauma or various neurosurgical interventions. This study scrutinizes the intricacies of CP, emphasizing its prevalence and associated complications, with a specific focus on custom-made porous hydroxyapatite (PHA) implants. The investigation spans 687 patients (with 80 patients of pediatric age, less than 14 years old) across 26 neurosurgical centers in five European countries. Methodologically, this study delves into patient characteristics, complications, and infection data through a comprehensive post-marketing on-site surveillance approach. Notably, infections emerged as the primary complication, affecting 41 patients (6% of implants) with a clear distinction in onset patterns between pediatric (with more infections, 10% versus 5.4% in adults and an earlier onset of complications) and adult populations. Out of these 41 cases, cranioplasty explantation was required in 30 patients, 4.4% of the total population. Furthermore, bifrontal decompression correlated with a significantly elevated infection risk as compared to unilateral decompression (12.5% versus 5.1%) which remains after the examination of possible confounding factors. These findings provide substantial insights into the complexities of CP, suggesting the necessity for tailored strategies in pediatric and adult cases and cautioning against bifrontal decompressions. Despite acknowledging limitations and calling for prospective studies with long term follow-up, this research advances our understanding of the use of PHA CP, guiding clinical decision-making and emphasizing the importance of customized approaches for diverse patient cohorts.
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Affiliation(s)
- Francesca Carolina Mannella
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milano, 20133 Milan, Italy; (M.F.); (G.D.N.)
| | - Francesca Faedo
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Marta Fumagalli
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milano, 20133 Milan, Italy; (M.F.); (G.D.N.)
| | - Giuseppe Danilo Norata
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milano, 20133 Milan, Italy; (M.F.); (G.D.N.)
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, CH-2900 Lugano, Switzerland;
| | - Franco Servadei
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
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5
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Breuskin D, Fischer G, Oertel J, Linsler S. Single-step resection and reconstruction of orbito-fronto-temporal pathologies using a PMMA CAD-implant. J Neurosurg Sci 2023; 67:679-687. [PMID: 35766207 DOI: 10.23736/s0390-5616.22.05758-7] [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: 11/16/2023]
Abstract
BACKGROUND Resection of bone infiltrating meningiomas of the sphenoid plane and the orbital walls is a highly challenging neurosurgical procedure. In this study, the authors present 11 cases of fronto-orbital and sphenoid wing meningioma which were subjected to tumor resection and cranioplasty using a pre-designed CAD PMMA-implant in one single staged procedure. METHODS Eleven cases were prospectively analyzed from January 2011 to December 2018. In all cases preoperative CT scans were performed and evaluated, in order to produce a customized PMMA-implant, fitting the osseous defect left after surgical resection of the predefined tumorous mass. Surgery was performed with standard techniques with the addition of availability of preplanned neuronavigational data as well as a matching template of the implant for intraoperative use. After tumor resection, cranioplasty followed using the predesigned PMMA implant. RESULTS Gross total resection was achieved in 82% (9 of 11 cases). Mean time of surgery for the combined procedure resulted in 223min±99min, with a mean blood loss of 427±192cc. Mean hospital stay for the combined procedure resulted in 11.5±3 days. In 18% of the cases (2/11), patients suffered from late onset infection of the implant and needed a surgical removal. CONCLUSIONS The presented data show that gross total resection and subsequent single staged bone reconstruction in osseous sphenoid wing and orbital rim meningiomas can be achieved using predesigned PMMA CAD implants with preplanned tumor resection borders with neuronavigational guidance.
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Affiliation(s)
- David Breuskin
- Department of Neurosurgery, Saarland University Medical Center, Faculty of Medicine, Saarland University, Homburg, Germany
| | - Gerrit Fischer
- Department of Neurosurgery, Saarland University Medical Center, Faculty of Medicine, Saarland University, Homburg, Germany
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Center, Faculty of Medicine, Saarland University, Homburg, Germany
| | - Stefan Linsler
- Department of Neurosurgery, Saarland University Medical Center, Faculty of Medicine, Saarland University, Homburg, Germany -
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6
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Chen K, Liang W, Zhu Q, Shen H, Yang Y, Li Y, Li H, Wang Y, Qian R. Clinical Outcomes After Cranioplasty With Titanium Mesh, Polyetheretherketone, or Composite Bone Cement: A Retrospective Study. J Craniofac Surg 2023; 34:2246-2251. [PMID: 37470720 PMCID: PMC10597434 DOI: 10.1097/scs.0000000000009542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/20/2023] [Indexed: 07/21/2023] Open
Abstract
Cranioplasty is a common neurosurgical procedure; however, the optimal material choice remains controversial. At the time of this writing, autologous bone, the preferred choice for primary cranioplasty, has a high incidence of complications such as infection and resorption, thus requiring frequent use of synthetic materials. Therefore, this study aimed to compare the clinical benefits of titanium mesh (Ti), polyetheretherketone (PEEK), and composite bone cement (CBC) in cranioplasty to provide a clear selection basis for clinicians and patients. This study retrospectively collected data from 207 patients who underwent cranioplasty with Ti (n=129), PEEK (n=54), and CBC (n=24) between January 2018 and December 2020 at Henan Provincial People's Hospital. Postoperative follow-up information after 6 months was used to compare the long-term effects of the 3 materials on the patients. There were no significant differences in the overall complication rate after cranioplasty among the 3 materials. However, subcutaneous effusion was more frequent with PEEK (24.07%) and CBC (20.83%) than with Ti (2.33%). Second, there were no significant differences in the increase in Glasgow Outcome Scale and Karnofsky Performance Status scores after cranioplasty among the 3 materials. Finally, we found that PEEK had the highest patient satisfaction and hospitalization cost, whereas the opposite was true for Ti. Although the surgical outcomes of the 3 implant materials were similar, an examination of clinical outcomes such as patient satisfaction showed significant differences, deepening people's perceptions of the 3 materials.
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Affiliation(s)
- Kui Chen
- Henan University People’s Hospital, Henan Provincial People’s Hospital
| | - Wenjia Liang
- Henan University People’s Hospital, Henan Provincial People’s Hospital
| | - Qingyun Zhu
- School of Clinical Medicine, Henan University, Henan Provincial People’s Hospital
| | - Haoyu Shen
- Zhenzhou University People’s Hospital, Henan Provincial People’s Hospital
| | - Youlei Yang
- Henan University People’s Hospital, Henan Provincial People’s Hospital
- Zhenzhou University People’s Hospital, Henan Provincial People’s Hospital
| | - Yanxin Li
- Zhenzhou University People’s Hospital, Henan Provincial People’s Hospital
| | - Haichun Li
- Department of Neurosurgery, Henan Provincial People’s Hospital
| | - Yonghong Wang
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University
| | - Rongjun Qian
- Department of Neurosurgery, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou University People’s Hospital, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
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7
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Ganau M, Calisto A, Thomas GPL. Considerations regarding FACE-Q® craniofacial as a newly developed QoL-PROMs questionnaire suitable for paediatric and adult cranioplasty patients. Neurosurg Rev 2023; 46:141. [PMID: 37335415 DOI: 10.1007/s10143-023-02054-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Mario Ganau
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK.
- Department of Neurosurgery, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
| | - Amedeo Calisto
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Neurosurgery, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Gregory P L Thomas
- Department of Plastic Surgery, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
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8
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Bedioui A, Elia A, Still M, Aboubakr O, Leclerc A, Planet M, Simboli GA, Moiraghi A, Fathallah H, Parraga E, Benevello C, Dezamis E, Roux A, Zanello M, Pallud J. Predictors of postoperative epidural hematomas after custom-made porous hydroxyapatite cranioplasty: a single-center experience of 194 consecutive cases. Neurosurg Rev 2023; 46:132. [PMID: 37264174 DOI: 10.1007/s10143-023-02039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/07/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
Cranioplasty is important for improving cosmesis and functional recovery after decompressive craniectomy. We assessed the incidence and predictors of post-cranioplasty epidural hematomas requiring surgical evacuation. A single-institution, retrospective study enrolled 194 consecutive patients who underwent a cranioplasty using custom-made hydroxyapatite between February 2008 and April 2022. Variables associated with postoperative epidural hematoma requiring surgical evacuation at the p < 0.1 level in unadjusted analysis were entered into multivariable analyses. Nine patients (4.6%) experienced postoperative epidural hematomas requiring evacuation, with time interval between craniectomy and cranioplasty <6 months (adjusted odds ratio (aOR), 20.75, p = 0.047), cranioplasty-to-bone shift > half of the bone thickness (aOR, 17.53, p = 0.008), >10 mm difference between pre-cranioplasty and post-cranioplasty midline brain shift contralateral to the cranioplasty (aOR, 17.26, p < 0.001), and non-resorbable duraplasty (aOR, 17.43, p = 0.011) identified as independent predictors. Seventeen patients (8.8%) experienced post-cranioplasty hydrocephalus requiring shunt placement. Twenty-six patients (13.4%) experienced postoperative infection. Sixteen patients (8.2%) had postoperative epileptic seizures. The identification of independent predictors of post-cranioplasty epidural hematomas requiring surgical evacuation will help identify at-risk patients, guide prophylactic care, and reduce morbidity of this common and important procedure.
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Affiliation(s)
- Aziz Bedioui
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Angela Elia
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Megan Still
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Oumaima Aboubakr
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Arthur Leclerc
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Department of Neurosurgery, Centre Hospitalier Universitaire Caen, Caen, France
| | - Martin Planet
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Giorgia Antonia Simboli
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Houssem Fathallah
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Eduardo Parraga
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Chiara Benevello
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
- Université Paris Cité, Paris, France.
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France.
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9
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Graziano F, Maugeri R, Giammalva GR, Lo Bue E, Zabbia G, Iacopino DG. Pulsed radiofrequency energy device (PEAK plasmablade™) and CustomBone ® Cranioplasty: an appealing surgical rendez-vous. Br J Neurosurg 2023; 37:518-524. [PMID: 30856015 DOI: 10.1080/02688697.2019.1584267] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 12/02/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND CustomBone® prosthesis is a widely recognized effective and successful technique for the reconstruction of cranial bone defects. Prior the cranioplasty implant, meticulous dissection within thick scar tissue is required. During this delicate surgical manoeuvre is vital to avoid damage to the skin flap itself and to the underlying cerebrovascular structures. We report our experience and potential applications of a novel, pulsed monopolar radiofrequency energy device (PEAK PlasmaBlade™, Medtronic plc). It reduced the incidence of post operativesubgaleal hematoma, the operative times and the intra operative blood loss following cranioplasty compared to the traditional scalpel and scissor dissection. METHODS The authors present a one centre case series study to review the indications, safety and efficacy of the PEAK PlasmaBlade™ in adult patientsunderwent cranioplasty. Two surgical techniques for tissue dissection were compared: PEAK PlasmaBlade™ versus scalpel and scissor dissection (SSD). Treatment outcomes following each of these surgical approaches, relative to rate of post-operative subgalealhematoma formation, hospital admission, and operative times were compared. RESULTS A total of 10 patients that had cranioplasty treatment were evaluated. In patients underwent scalp dissection with the PEAKPlasmaBlade™, we observed a reduction in the operative times, in the subgaleal hematoma formation and then in the hospital stay. CONCLUSION PEAK PlasmaBlade™ revealed to be a safe and effective device in tissues dissection for cranioplasty implant. It provided reduction of the rate of subgaleal hematoma formation, operating times and less potential risk to damage cerebrovascular structures.
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Affiliation(s)
- F Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - R Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - G R Giammalva
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - E Lo Bue
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - G Zabbia
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - D G Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
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10
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Clynch AL, Norrington M, Mustafa MA, Richardson GE, Doherty JA, Humphries TJ, Gillespie CS, Keshwara SM, McMahon CJ, Islim AI, Jenkinson MD, P Millward C, Brodbelt AR. Cranial meningioma with bone involvement: surgical strategies and clinical considerations. Acta Neurochir (Wien) 2023; 165:1355-1363. [PMID: 36877330 PMCID: PMC10140130 DOI: 10.1007/s00701-023-05535-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/11/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Intracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients. METHODS A single-centre, retrospective cohort study (January 2010-August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0. RESULTS Thirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary 'on-table' cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%). CONCLUSION Meningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.
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Affiliation(s)
- Abigail L Clynch
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK.
| | - Max Norrington
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Mohammad A Mustafa
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - George E Richardson
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - John A Doherty
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Thomas J Humphries
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Conor S Gillespie
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Sumirat M Keshwara
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Catherine J McMahon
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Abdurrahman I Islim
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Michael D Jenkinson
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Christopher P Millward
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Andrew R Brodbelt
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK.,The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
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11
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Gerstl JVE, Rendon LF, Burke SM, Doucette J, Mekary RA, Smith TR. Complications and cosmetic outcomes of materials used in cranioplasty following decompressive craniectomy-a systematic review, pairwise meta-analysis, and network meta-analysis. Acta Neurochir (Wien) 2022; 164:3075-3090. [PMID: 35593924 DOI: 10.1007/s00701-022-05251-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Optimal reconstruction materials for cranioplasty following decompressive craniectomy (DC) remain unclear. This systematic review, pairwise meta-analysis, and network meta-analysis compares cosmetic outcomes and complications of autologous bone grafts and alloplasts used for cranioplasty following DC. METHOD PubMed, Embase, and Cochrane were searched from inception until April 2021. A random-effects pairwise meta-analysis was used to compare pooled outcomes and 95% confidence intervals (CIs) of autologous bone to combined alloplasts. A frequentist network meta-analysis was subsequently conducted to compare multiple individual materials. RESULTS Of 2033 articles screened, 30 studies were included, consisting of 29 observational studies and one randomized control trial. Overall complications were statistically significantly higher for autologous bone compared to combined alloplasts (RR = 1.56, 95%CI = 1.14-2.13), hydroxyapatite (RR = 2.60, 95%CI = 1.17-5.78), polymethylmethacrylate (RR = 1.50 95%CI = 1.08-2.08), and titanium (Ti) (RR = 1.56 95%CI = 1.03-2.37). Resorption occurred only in autologous bone (15.1%) and not in alloplasts (0.0%). When resorption was not considered, there was no difference in overall complications between autologous bone and combined alloplasts (RR = 1.00, 95%CI = 0.75-1.34), nor between any individual materials. Dehiscence was lower for autologous bone compared to combined alloplasts (RR = 0.39, 95%CI = 0.19-0.79) and Ti (RR = 0.34, 95%CI = 0.15-0.76). There was no difference between autologous bone and combined alloplasts with respect to infection (RR = 0.85, 95%CI = 0.56-1.30), migration (RR = 1.36, 95%CI = 0.63-2.93), hematoma (RR = 0.98, 95%CI = 0.53-1.79), seizures (RR = 0.83, 95%CI = 0.29-2.35), satisfactory cosmesis (RR = 0.88, 95%CI = 0.71-1.08), and reoperation (RR = 1.66, 95%CI = 0.90-3.08). CONCLUSIONS Bone resorption is only a consideration in autologous cranioplasty compared to bone substitutes explaining higher complications for autologous bone. Dehiscence is higher in alloplasts, particularly in Ti, compared to autologous bone.
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Affiliation(s)
- Jakob V E Gerstl
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA. .,University College London Medical School, London, WC1E 6DE, UK.
| | - Luis F Rendon
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Department of Neurosurgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Shane M Burke
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Department of Neurosurgery, Tufts Medical Center, Boston, MA, 02111, USA
| | - Joanne Doucette
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, 02115, USA
| | - Rania A Mekary
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, 02115, USA
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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12
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Analysis of PMMA versus CaP titanium-enhanced implants for cranioplasty after decompressive craniectomy: a retrospective observational cohort study. Neurosurg Rev 2022; 45:3647-3655. [PMID: 36222944 DOI: 10.1007/s10143-022-01874-5] [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: 03/09/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 10/17/2022]
Abstract
Numerous materials of implants used for cranioplasty after decompressive craniectomy (DC) have been investigated to meet certain demanded key features, such as stability, applicability, and biocompatibility. We aimed to evaluate the feasibility and safety of biocompatible calcium-phosphate (CaP) implants for cranioplasty compared to polymethylmethacrylate (PMMA) implants. In this retrospective observational cohort study, the medical records of all patients who underwent cranioplasty between January 1st, 2015, and January 1st, 2022, were reviewed. Demographic, clinical, and diagnostic data were collected. Eighty-two consecutive patients with a mean age of 52 years (range 22-72 years) who received either a PMMA (43/82; 52.4%) or CaP (39/82; 47.6%) cranial implant after DC were included in the study. Indications for DC were equally distributed in both groups. Time from DC to cranioplasty was 143.8 ± 17.5 days (PMMA) versus 98.5 ± 10.4 days (CaP). The mean follow-up period was 34.9 ± 27.1 months. Postoperative complications occurred in 13 patients with PMMA and 6 in those with CaP implants (13/43 [30.2%] vs. 6/39 [15.4%]; p = 0.115). Revision surgery with implant removal was necessary for 9 PMMA patients and in 1 with a CaP implant (9/43 [20.9%] vs. 1/39 [2.6%]; p = 0.0336); 6 PMMA implants were removed due to surgical site infection (SSI) (PMMA 6/43 [14%] vs. CaP 0/39 [0%]; p = 0.012). In this study, a biocompatible CaP implant seems to be superior to a PMMA implant in terms of SSI and postoperative complications. The absence of SSI supports the idea of the biocompatible implant material with its ability for osseointegration.
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13
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Millward CP, Doherty JA, Mustafa MA, Humphries TJ, Islim AI, Richardson GE, Clynch AL, Gillespie CS, Keshwara SM, Kolamunnage-Dona R, Brodbelt AR, Jenkinson MD, Duncan C, Sinha A, McMahon CJ. Cranioplasty with hydroxyapatite or acrylic is associated with a reduced risk of all-cause and infection-associated explantation. Br J Neurosurg 2022; 36:385-393. [DOI: 10.1080/02688697.2022.2077311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Christopher P. Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - John A. Doherty
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Thomas J. Humphries
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Abdurrahman I. Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | - Abigail L. Clynch
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Andrew R. Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Michael D. Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Christian Duncan
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Ajay Sinha
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Catherine J. McMahon
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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14
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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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15
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The Antibiotic Immersion of Custom-Made Porous Hydroxyapatite Cranioplasty. J Craniofac Surg 2022; 33:1464-1468. [DOI: 10.1097/scs.0000000000008363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/17/2021] [Indexed: 11/27/2022] Open
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16
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Di Rienzo A, Colasanti R, Dobran M, Formica F, Della Costanza M, Carrassi E, Aiudi D, Iacoangeli M. Management of infected hydroxyapatite cranioplasty: Is salvage feasible? BRAIN AND SPINE 2022; 2:100907. [PMID: 36248178 PMCID: PMC9560697 DOI: 10.1016/j.bas.2022.100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
Introduction The use of hydroxyapatite cranioplasties has grown progressively over the past few decades. The peculiar biological properties of this material make it particularly suitable for patients with decompressive craniectomy where bone reintegration is a primary objective. However, hydroxyapatite infection rates are similar to those of other reconstructive materials. Research question We investigated if infected hydroxyapatite implants could be saved or not. Materials and methods We present a consecutive series over a 10-year period of nine patients treated for hydroxyapatite cranioplasty infection. Clinical and radiological data from admission and follow-up, photo and video material documenting the different phases of infection assessment and treatment, and final outcomes were retrospectively reviewed in an attempt to identify the best options and possible pitfalls in a case-by-case decision-making process. Results Five unilateral and four bifrontal implants became infected. Wound rupture with cranioplasty exposure was the most common presentation. At revision, all implants were ossified, requiring a new craniotomy to clean the purulent epidural collections. The cranioplasty was fully saved in one hemispheric and 2 bifrontal implants and partially saved in the remaining 2 bifrontal implants. A complete cranioplasty removal was needed in the other 4 cases, but immediate cranial reconstruction was possible in 2. Skin defects were covered by free flaps in 3 cases. Four patients underwent adjunctive hyperbaric therapy, which was effective in one case. Discussion and conclusion In our experience, infected hydroxyapatite cranioplasty management is complex and requires a multidisciplinary approach. Salvage of a hydroxyapatite implant is possible under specific circumstances. We present a series of 9 patients treated for hydroxyapatite cranioplasty infection. One hemispheric and 2 bifrontal implants were fully saved, 2 bifrontal only partially. A complete removal was needed in 4 cases, but immediate cranial reconstruction was possible in 2. Infected hydroxyapatite cranioplasties salvage is complex, but possible under specific circumstances.
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17
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Reconstruction of the Occipital and Parietal Congenital Defect with 3D Custom-Made Titanium Prosthesis: A Case Report with Four and a Half Years of Follow-Up and a Brief Review of Literature. Case Rep Dent 2021; 2021:7027701. [PMID: 34721909 PMCID: PMC8550828 DOI: 10.1155/2021/7027701] [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: 05/11/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Management of patients with congenital skull defects requires a multidisciplinary approach. Considering the defect's location and size, brain protection, and the cosmetic outcome makes such reconstructions challenging. Due to limited resemblance to skull contour and donor site morbidity of autogenous bone grafts, alloplastic materials are widely used for skull reconstructions. Titanium alloys have proper strength values, low infection rates, favorable osseointegration property, and excellent marginal adaptability when manufactured by computer-aided design (CAD) and computer-aided manufacturing (CAM). A 13-year-old female patient presented with congenital defects at the superior third of occipital bone and posterior thirds of the bilateral parietal bones. On CT scan, the exact size and shape of the defect were determined. Using CAD/CAM, a 3D virtual model of the prosthesis was designed and then printed with titanium alloy (TiAl6V4) via additive manufacturing method. The prosthesis was placed on the defect in a total surgery time of only 90 minutes. On 4.5 years of follow-up, the contour of the skull was ideal and the skin over the defect and neurologic status was intact. Due to their biocompatibility and rigidity, custom-made titanium prostheses are promising options for reconstructing complex skull defects.
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18
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Lo Bue E, Scalia G, Nicoletti GF, Maugeri R, Iacopino DG, Zabbia G, Umana GE, Graziano F. The Boundless World of Cranioplasty: A Multicenter Retrospective Study and Therapeutic Flow-Chart Patient-Specific Based. J Craniofac Surg 2021; 32:2758-2762. [PMID: 34727474 DOI: 10.1097/scs.0000000000007903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cranioplasty is both a functional and aesthetical therapeutic option. In the clinical scenario every cranioplasty's material is potentially qualified to achieve the goal of calvarian reconstruction but there is a lack of agreement about the optimum choice, especially between the heterologous ones. The choice of cranioplasty widely depends on surgeon's personal preferences. In this retrospective multicentric study a comparative analysis of hydroxyapatite or titanium cranioplasties was carried on analyzing the main factors considered by the surgeon to choose a material rather than another one. Our results and data were compared with those reported in the scientific literature and a flow-chart regarding the therapeutic approach in the choice of the most suitable cranioplasty was proposed and discussed. METHODS The authors present a multicentric study considering 2 groups of patients who underwent 2 different kinds of cranioplasty: hydroxyapatite and titanium. The outcomes measures included the surgical timing and the maintenance of post-operative subgaleal drain. RESULTS A total of 40 patients that had cranioplasty treatment were evaluated. The surgical technique was analyzed. In patients that underwent titanium cranioplasty we observed a reduction in the operative times and in subgaleal drain maintenance. In relation to the age, comorbidity, and neurological status a score, called most suitable material (MSM), was elaborated and a therapeutic algorithm is proposed. CONCLUSIONS This study confirms the known advantages and drawback of titanium and hydroxyapatite prostheses. Thanks to the lessons learned from our experience on this field, we elaborated the MSM score that coupled with the therapeutic flow-chart proposed could address the choice of the MSM for a specific patient.
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Affiliation(s)
- Enrico Lo Bue
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania
| | | | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo
| | - Domenico Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo
| | - Giovanni Zabbia
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Francesca Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania
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19
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Fountain DM, Henry J, Honeyman S, O'Connor P, Sekhon P, Piper RJ, Edlmann E, Martin M, Whiting G, Turner C, Mee H, Joannides AJ, Kolias AG, Hutchinson PJ. First Report of a Multicenter Prospective Registry of Cranioplasty in the United Kingdom and Ireland. Neurosurgery 2021; 89:518-526. [PMID: 34192745 DOI: 10.1093/neuros/nyab220] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are many questions that remain unanswered regarding outcomes following cranioplasty including the timing of cranioplasty following craniectomy as well as the material used. OBJECTIVE To establish and evaluate 30-d outcomes for all cranial reconstruction procedures in the United Kingdom (UK) and Ireland through a prospective multicenter cohort study. METHODS Patients undergoing cranioplasty insertion or revision between June 1, 2019 and November 30, 2019 in 25 neurosurgical units were included. Data collected include demographics, craniectomy date and indication, cranioplasty material and date, and 30-d outcome. RESULTS In total, 313 operations were included, consisting of 255 new cranioplasty insertions and 58 revisions. Of the new insertions, the most common indications for craniectomy were traumatic brain injury (n = 110, 43%), cerebral infarct (n = 38, 15%), and aneurysmal subarachnoid hemorrhage (n = 30, 12%). The most common material was titanium (n = 163, 64%). Median time to cranioplasty was 244 d (interquartile range 144-385), with 37 new insertions (15%) within or equal to 90 d. In 30-d follow-up, there were no mortalities. There were 14 readmissions, with 10 patients sustaining a wound infection within 30 d (4%). Of the 58 revisions, the most common reason was due to infection (n = 33, 59%) and skin breakdown (n = 13, 23%). In 41 (71%) cases, the plate was removed during the revision surgery. CONCLUSION This study is the largest prospective study of cranioplasty representing the first results from the UK Cranial Reconstruction Registry, a first national registry focused on cranioplasty with the potential to address outstanding research questions for this procedure.
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Affiliation(s)
- Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Jack Henry
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Republic of Ireland
| | - Susan Honeyman
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | | | - Priya Sekhon
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Ellie Edlmann
- Department of Neurosurgery, University of Plymouth, Plymouth, UK
| | | | - Gemma Whiting
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
| | - Carole Turner
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
| | - Harry Mee
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
| | - Alexis J Joannides
- Orion MedTech Ltd CIC, Cambridge, UK
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
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Giese H, Antritter J, Unterberg A, Beynon C. Long-Term Results of Neurological Outcome, Quality of Life, and Cosmetic Outcome After Cranioplastic Surgery: A Single Center Study of 202 Patients. Front Neurol 2021; 12:702339. [PMID: 34354667 PMCID: PMC8329417 DOI: 10.3389/fneur.2021.702339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/18/2021] [Indexed: 01/03/2023] Open
Abstract
Objective: An increased interest in the surgical procedures of decompressive craniectomy (DC) and subsequent cranioplasty (CP) has emerged during the last decades with specific focus on mortality and complication rates. The aim of the present study was to evaluate long-term neurological and cosmetic outcomes as well as Quality of Life (QoL) after CP surgery. Methods: We retrospectively reviewed the medical records of CP patients treated at our institution between 2004 and 2014 and performed a follow-up examination, with evaluation of neurological outcome using the modified Rankin Scale (mRS) and the Glasgow outcome scale (GOS), QoL (SF-36 and EQ-5D-3L). Furthermore, the cosmetic results after CP were analyzed. Results: A total of 202 CP-patients were included in the present study. The main indications for DC and subsequent CP were space-occupying cerebral ischemia (32%), traumatic brain injury (TBI, 26%), intracerebral or subarachnoid hemorrhage (32%) and infection (10%). During a mean follow-up period of 91.9 months 46/42.6% of patients had a favorable neurological outcome (mRS ≤ 3/GOS ≥ 4). Patients with ischemia had a significant worse outcome (mRS 4.3 ± 1.5) compared with patients after TBI (3.1 ± 2.3) and infectious diseases requiring CP (2.4 ± 2.3). The QoL analysis showed that <1/3rd of patients (31.2%) had a good QoL (SF-36) with a mean EQ-5D-VAS of 59 ± 26. Statistical analysis confirmed a significant worse QoL of ischemia patients compared to other groups whereas multivariate regression analysis showed no other factors which may had an impact on the QoL. The majority (86.5%) of patients were satisfied with the cosmetic result after CP and regression analysis showed no significant factors associated with unfavorable outcomes. Conclusion: Long-term outcome and QoL after CP were significantly influenced by the medical condition requiring DC. Early detection and evaluation of QoL after CP may improve the patient's outcome due to an immediate initiation of targeted therapies (e.g., occupational- or physiotherapy).
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Affiliation(s)
- Henrik Giese
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jennifer Antritter
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christopher Beynon
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
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21
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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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22
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Henry J, Amoo M, Taylor J, O'Brien DP. Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression. Neurosurgery 2021; 89:383-394. [PMID: 34100535 DOI: 10.1093/neuros/nyab180] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cranioplasty is a ubiquitous neurosurgical procedure consisting of reconstruction of a pre-existing calvarial defect. Many materials are available, including polymethylmethacrylate in hand-moulded (hPMMA) and prefabricated (pPMMA) form, hydroxyapatite (HA), polyetheretherketone (PEEK) and titanium (Ti). OBJECTIVE To perform a network meta-analysis (NMA) to assess the relationship between materials and complications of cranioplasty. METHODS PubMed/MEDLINE, Google Scholar, EMBASE, Scopus, and The Cochrane Library were searched from January 1, 1990 to February 14, 2021. Studies detailing rates of any of infections, implant exposure, or revision surgery were included. A frequentist NMA was performed for each complication. Risk ratios (RRs) with 95% CIs were calculated for each material pair. RESULTS A total of 3620 abstracts were screened and 31 full papers were included. Surgical revision was reported in 18 studies and occurred in 316/2032 cases (14%; 95% CI 11-17). PEEK had the lowest risk of re-operation with a rate of 8/157 (5%; 95% CI 0-11) in 5 studies, superior to autografts (RR 0.20; 95% CI 0.07-0.57), hPMMA (RR 0.20; 95% CI 0.07-0.60), Ti (RR 0.39; 95% CI 0.17-0.92), and pPMMA (RR 0.14; 95% CI 0.04-0.51). Revision rate was 131/684 (19%; 95% CI 13-25; 10 studies) in autografts, 61/317 (18%; 95%CI 9-28; 7 studies) in hPMMA, 84/599 (13%; 95% CI 7-19; 11 studies) in Ti, 7/59 (9%; 95% CI 1-23; 3 studies) in pPMMA, and 25/216 (12%; 95% CI 4-24; 4 studies) in HA. Infection occurred in 463/4667 (8%; 95% CI 6-11) and implant exposure in 120/1651 (6%; 95% CI 4-9). CONCLUSION PEEK appears to have the lowest risk of cranioplasty revision, but further research is required to determine the optimal material.
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Affiliation(s)
- Jack Henry
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Michael Amoo
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - Joseph Taylor
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - David P O'Brien
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
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23
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Giese H, Meyer J, Unterberg A, Beynon C. Long-term complications and implant survival rates after cranioplastic surgery: a single-center study of 392 patients. Neurosurg Rev 2021; 44:1755-1763. [PMID: 32844249 PMCID: PMC8121727 DOI: 10.1007/s10143-020-01374-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
Cranioplasty (CP) is a standard procedure in neurosurgical practice for patients after (decompressive) craniectomy. However, CP surgery is not standardized, is carried out in different ways, and is associated with considerable complication rates. Here, we report our experiences with the use of different CP materials and analyze long-term complications and implant survival rates. We retrospectively studied patients who underwent CP surgery at our institution between 2004 and 2014. Binary logistic regression analysis was performed in order to identify risk factors for the development of complications. Kaplan-Meier analysis was used to estimate implant survival rates. A total of 392 patients (182 females, 210 males) with a mean age of 48 years were included. These patients underwent a total of 508 CP surgeries. The overall complication rate of primary CP was 33.2%, due to bone resorption/loosening (14.6%) and graft infection (7.9%) with a mean implant survival of 120 ± 5 months. Binary logistic regression analysis showed that young age (< 30 years) (p = 0.026, OR 3.150), the presence of multidrug-resistant bacteria (p = 0.045, OR 2.273), and cerebrospinal fluid (CSF) shunt (p = 0.001, OR 3.137) were risk factors for postoperative complications. The use of titanium miniplates for CP fixation was associated with reduced complication rates and bone flap osteolysis as well as longer implant survival rates. The present study highlights the risk profile of CP surgery. Young age (< 30 years) and shunt-dependent hydrocephalus are associated with postoperative complications especially due to bone flap autolysis. Furthermore, a rigid CP fixation seems to play a crucial role in reducing complication rates.
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Affiliation(s)
- Henrik Giese
- Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Jennifer Meyer
- Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christopher Beynon
- Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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24
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Amelot A, Nataloni A, François P, Cook AR, Lejeune JP, Baroncini M, Hénaux PL, Toussaint P, Peltier J, Buffenoir K, Hamel O, Hieu PD, Chibbaro S, Kehrli P, Lahlou MA, Menei P, Lonjon M, Mottolese C, Peruzzi P, Mahla K, Scarvada D, Le Guerinel C, Caillaud P, Nuti C, Pommier B, Faillot T, Iakovlev G, Goutagny S, Lonjon N, Cornu P, Bousquet P, Sabatier P, Debono B, Lescure JP, Vicaut E, Froelich S. Security and reliability of CUSTOMBONE cranioplasties: A prospective multicentric study. Neurochirurgie 2021; 67:301-309. [PMID: 33667533 DOI: 10.1016/j.neuchi.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Repairing bone defects generated by craniectomy is a major therapeutic challenge in terms of bone consolidation as well as functional and cognitive recovery. Furthermore, these surgical procedures are often grafted with complications such as infections, breaches, displacements and rejections leading to failure and thus explantation of the prosthesis. OBJECTIVE To evaluate cumulative explantation and infection rates following the implantation of a tailored cranioplasty CUSTOMBONE prosthesis made of porous hydroxyapatite. One hundred and ten consecutive patients requiring cranial reconstruction for a bone defect were prospectively included in a multicenter study constituted of 21 centres between December 2012 and July 2014. Follow-up lasted 2 years. RESULTS Mean age of patients included in the study was 42±15 years old (y.o), composed mainly by men (57.27%). Explantations of the CUSTOMBONE prosthesis were performed in 13/110 (11.8%) patients, significantly due to infections: 9/13 (69.2%) (p<0.0001), with 2 (15.4%) implant fracture, 1 (7.7%) skin defect and 1 (7.7%) following the mobilization of the implant. Cumulative explantation rates were successively 4.6% (SD 2.0), 7.4% (SD 2.5), 9.4% (SD 2.8) and 11.8% (SD 2.9%) at 2, 6, 12 and 24 months. Infections were identified in 16/110 (14.5%): 8/16 (50%) superficial and 8/16 (50%) deep. None of the following elements, whether demographic characteristics, indications, size, location of the implant, redo surgery, co-morbidities or medical history, were statistically identified as risk factors for prosthesis explantation or infection. CONCLUSION Our study provides relevant clinical evidence on the performance and safety of CUSTOMBONE prosthesis in cranial procedures. Complications that are difficulty incompressible mainly occur during the first 6 months, but can appear at a later stage (>1 year). Thus assiduous, regular and long-term surveillances are necessary.
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Affiliation(s)
- A Amelot
- Neurosurgery department, Hôpital de Bretonneau, Tours, France.
| | - A Nataloni
- Clinical research department, Finceramica Faenza S.p.A, Ravenna, Italy
| | - P François
- Neurosurgery department, Hôpital de Bretonneau, Tours, France
| | - A-R Cook
- Neurosurgery department, Hôpital de Bretonneau, Tours, France
| | - J-P Lejeune
- Neurosurgery department, CHRU Lille, Lille, France
| | - M Baroncini
- Neurosurgery department, CHRU Lille, Lille, France
| | - P-L Hénaux
- Neurosurgery department, CHU Rennes, Rennes, France
| | - P Toussaint
- Neurosurgery department, CHU Amiens, Amiens, France
| | - J Peltier
- Neurosurgery department, CHU Amiens, Amiens, France
| | - K Buffenoir
- Neurosurgery department, CHU Nantes, Nantes, France
| | - O Hamel
- Neurosurgery department, CHU Nantes, Nantes, France
| | - P Dam Hieu
- Neurosurgery department, CHU Brest, Brest, France
| | - S Chibbaro
- Neurosurgery department, CHU Strasbourg, Strasbourg, France
| | - P Kehrli
- Neurosurgery department, CHU Angers, Angers, France
| | - M A Lahlou
- Neurosurgery department, CHU Strasbourg, Strasbourg, France
| | - P Menei
- Neurosurgery department, CHU Angers, Angers, France
| | - M Lonjon
- Neurosurgery department, CHU Nice, Nice, France
| | - C Mottolese
- Neurosurgery department, CHU Neurologique Lyon, Lyon, France
| | - P Peruzzi
- Neurosurgery department, CHU Maison Blanche, Reims, France
| | - K Mahla
- Neurosurgery department, clinique du Tonkin, Villeurbanne, France
| | - D Scarvada
- Neurosurgery department, CHU La Timone, Marseille, France
| | - C Le Guerinel
- Neurosurgery department, CHU Henri Mondor, Creteil, France
| | - P Caillaud
- Neurosurgery department, CH de la Côte Basque, Bayonne, France
| | - C Nuti
- Neurosurgery department, CHU St Etienne, St Etienne, France
| | - B Pommier
- Neurosurgery department, CHU St Etienne, St Etienne, France
| | - T Faillot
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - G Iakovlev
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - S Goutagny
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - N Lonjon
- Neurosurgery department, CHU Gui de Chauliac, Montpellier, France
| | - P Cornu
- Neurosurgery department, CHU Pitié-Salpêtrière, Paris, France
| | - P Bousquet
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - P Sabatier
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - B Debono
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - J-P Lescure
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - E Vicaut
- Clinical research unit (URC), Hôpital de Lariboisière, APHP, Paris, France
| | - S Froelich
- Neurosurgery department, Hôpital de Lariboisière, APHP, Paris, France
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25
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Foley KT, Woodard EJ, Slotkin JR, Mayotte CK, Baldwin AC, Brown MC, Hess BJ. Cranial flap fixation in sheep using a resorbable bone adhesive. J Neurosurg 2021; 134:621-629. [PMID: 32032955 DOI: 10.3171/2019.11.jns192806] [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] [Received: 10/14/2019] [Accepted: 11/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' goal in this study was to investigate the use of a novel, bioresorbable, osteoconductive, wet-field mineral-organic bone adhesive composed of tetracalcium phosphate and phosphoserine (TTCP-PS) for cranial bone flap fixation and compare it with conventional low-profile titanium plates and self-drilling screws. METHODS An ovine craniotomy surgical model was used to evaluate the safety and efficacy of TTCP-PS over 2 years. Bilateral cranial defects were created in 41 sheep and were replaced in their original position. The gaps (kerfs) were completely filled with TTCP-PS (T1 group), half-filled with TTCP-PS (T2 group), or left empty and the flaps fixated by plates and screws as a control (C group). At 12 weeks, 1 year, and 2 years following surgery, the extent of bone healing, local tissue effects, and remodeling of the TTCP-PS were analyzed using macroscopic observations and histopathological and histomorphometric analyses. Flap fixation strength was evaluated by biomechanical testing at 12 weeks and 1 year postoperatively. RESULTS No adverse local tissue effects were observed in any group. At 12 weeks, the bone flap fixation strengths in test group 1 (1689 ± 574 N) and test group 2 (1611 ± 501 N) were both statistically greater (p = 0.01) than that in the control group (663 ± 385 N). From 12 weeks to 1 year, the bone flap fixation strengths increased significantly (p < 0.05) for all groups. At 1 year, the flap fixation strength in test group 1 (3240 ± 423 N) and test group 2 (3212 ± 662 N) were both statistically greater (p = 0.04 and p = 0.02, respectively) than that in the control group (2418 ± 1463 N); however, there was no statistically significant difference in the strengths when comparing the test groups at both timepoints. Test group 1 had the best overall performance based on histomorphometric evaluation and biomechanical testing. At 2 years postoperatively, the kerfs filled with TTCP-PS had histological evidence of osteoconduction and replacement of TTCP-PS by bone with nearly complete osteointegration. CONCLUSIONS TTCP-PS was demonstrated to be safe and effective for cranial flap fixation in an ovine model. In this study, the bioresorbable, osteoconductive bone adhesive appeared to have multiple advantages over standard plate-and-screw bone flap fixation, including biomechanical superiority, more complete and faster bony healing across the flap kerfs without fibrosis, and the minimization of bone flap and/or hardware migration and loosening. These properties of TTCP-PS may improve human cranial bone flap fixation and cranioplasty.
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Affiliation(s)
- Kevin T Foley
- 1Department of Neurosurgery, University of Tennessee Health Science Center and Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Eric J Woodard
- 2Department of Neurosurgery, New England Baptist Hospital, Boston, Massachusetts
| | - Jonathan R Slotkin
- 3Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania
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26
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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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27
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Panseri S, Montesi M, Hautcoeur D, Dozio SM, Chamary S, De Barra E, Tampieri A, Leriche A. Bone-like ceramic scaffolds designed with bioinspired porosity induce a different stem cell response. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:3. [PMID: 33471246 PMCID: PMC7817586 DOI: 10.1007/s10856-020-06486-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/18/2020] [Indexed: 05/12/2023]
Abstract
Biomaterial science increasingly seeks more biomimetic scaffolds that functionally augment the native bone tissue. In this paper, a new concept of a structural scaffold design is presented where the physiological multi-scale architecture is fully incorporated in a single-scaffold solution. Hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) bioceramic scaffolds with different bioinspired porosity, mimicking the spongy and cortical bone tissue, were studied. In vitro experiments, looking at the mesenchymal stem cells behaviour, were conducted in a perfusion bioreactor that mimics the physiological conditions in terms of interstitial fluid flow and associated induced shear stress. All the biomaterials enhanced cell adhesion and cell viability. Cortical bone scaffolds, with an aligned architecture, induced an overexpression of several late stage genes involved in the process of osteogenic differentiation compared to the spongy bone scaffolds. This study reveals the exciting prospect of bioinspired porous designed ceramic scaffolds that combines both cortical and cancellous bone in a single ceramic bone graft. It is prospected that dual core shell scaffold could significantly modulate osteogenic processes, once implanted in patients, rapidly forming mature bone tissue at the tissue interface, followed by subsequent bone maturation in the inner spongy structure.
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Affiliation(s)
- Silvia Panseri
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Italy.
| | - Monica Montesi
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Italy
| | - Dominique Hautcoeur
- Belgian Ceramic Research Centre, Avenue Gouverneur Cornez 4, B-7000, Mons, Belgium
| | - Samuele M Dozio
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Italy
| | - Shaan Chamary
- Université Polytechnique Hauts-de-France, Laboratoire des Matériaux Céramiques et Procédés Associés, 59313, Valenciennes, France
| | - Eamonn De Barra
- University of Limerick, Bernal Institute, Limerick, V94 T9PX, Ireland
| | - Anna Tampieri
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Italy
| | - Anne Leriche
- Université Polytechnique Hauts-de-France, Laboratoire des Matériaux Céramiques et Procédés Associés, 59313, Valenciennes, France
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28
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Zhu S, Chen Y, Lin F, Chen Z, Jiang X, Zhang J, Wang J. Complications following titanium cranioplasty compared with nontitanium implants cranioplasty: A systematic review and meta-analysis. J Clin Neurosci 2020; 84:66-74. [PMID: 33485602 DOI: 10.1016/j.jocn.2020.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/31/2020] [Accepted: 12/06/2020] [Indexed: 01/11/2023]
Abstract
Decompressive craniectomy is widely used to treat medically refractory intracranial hypertension. There were still few studies focusing on the complications between titanium cranioplasty with non-titanium materials cranioplasty. Our systematic review and meta-analysis aimed to assess the complications following titanium cranioplasty and to make a comparison with nontitanium materials. A systematic review was used to review titanium cranioplasty characters in recent articles. A systematic literature review and meta-analysis were performed by using PubMed/MEDLINE, Scopus, the Cochrane databases and Embase for studies reporting on cranioplasty procedures that compared complication outcomes between titanium with non-titanium materials. The final 15 studies met inclusion criteria and represented 2258 cranioplasty procedures (896 titanium, 1362 nontitanium materials). Overall complications included surgical site infection, hematoma, implant exposure, seizure, cerebrospinal fluid leak, imprecise fitting. Titanium cranioplasty was associated with a significant decrease in overall complications rate (OR, 0.72; P = 0.007), hematoma rate (OR, 0.31; P = 0.0003) and imprecise fitting rate (OR, 0.35; P = 0.04). However, it also suggested that titanium cranioplasty can be greatly increased implant exposure rate (OR, 4.11; P < 0.00001). Our results confirmed the advantages of titanium cranioplasty in reducing complications including hematoma, imprecise fitting, and also suggested that clinicians should pay more attention to postoperative implant exposure. With new synthetic materials emerging, it would also be interesting to study the cost-effect and functional outcomes associated with cranioplasty materials.
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Affiliation(s)
- Sihan Zhu
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Yinsheng Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Fuhua Lin
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Zhenghe Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Xiaobing Jiang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Ji Zhang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Jian Wang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China.
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29
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In situ bone regeneration of large cranial defects using synthetic ceramic implants with a tailored composition and design. Proc Natl Acad Sci U S A 2020; 117:26660-26671. [PMID: 33046631 PMCID: PMC7604495 DOI: 10.1073/pnas.2007635117] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Large cranial reconstructions are increasingly performed worldwide and still represent a substantial clinical challenge. The gold standard, autologous bone, has limited availability and high donor-site morbidity. Current alloplastic materials are associated with high complication and failure rates. This study shows the capacity of a customized, purely synthetic, 3D-manufactured bioceramic implant to regenerate and restore large cranial defects with mature, well-vascularized bone, with a morphology, ultrastructure, and composition similar to those of native skull bone. This approach triggers the regenerative potential of host tissue by tailoring the implant composition and design. The regeneration of large defects using purely synthetic material without adjunct cell therapy or growth factors represents a major advancement for rehabilitating patients in need of large cranial reconstructions. The repair of large cranial defects with bone is a major clinical challenge that necessitates novel materials and engineering solutions. Three-dimensionally (3D) printed bioceramic (BioCer) implants consisting of additively manufactured titanium frames enveloped with CaP BioCer or titanium control implants with similar designs were implanted in the ovine skull and at s.c. sites and retrieved after 12 and 3 mo, respectively. Samples were collected for morphological, ultrastructural, and compositional analyses using histology, electron microscopy, and Raman spectroscopy. Here, we show that BioCer implants provide osteoinductive and microarchitectural cues that promote in situ bone regeneration at locations distant from existing host bone, whereas bone regeneration with inert titanium implants was confined to ingrowth from the defect boundaries. The BioCer implant promoted bone regeneration at nonosseous sites, and bone bonding to the implant was demonstrated at the ultrastructural level. BioCer transformed to carbonated apatite in vivo, and the regenerated bone displayed a molecular composition indistinguishable from that of native bone. Proof-of-principle that this approach may represent a shift from mere reconstruction to in situ regeneration was provided by a retrieved human specimen, showing that the BioCer was transformed into well-vascularized osteonal bone, with a morphology, ultrastructure, and composition similar to those of native human skull bone.
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Zaed I, Rossini Z, Faedo F, Fontanella MM, Cardia A, Servadei F. Long-term follow-up of custom-made porous hydroxyapatite cranioplasty in adult patients: a multicenter European study. Can we trust self-reported complications? J Neurosurg Sci 2020; 66:335-341. [PMID: 32989979 DOI: 10.23736/s0390-5616.20.05138-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cranioplasty is a surgical intervention aiming to re-establish the integrity of skull defects. Autologous bone and different heterologous materials are used for this purpose, with various reported related complications. The aim of the study was to evaluate the complication rate in a multicentric cohort of patients underwent porous hydroxyapatite (PHA) cranioplasty implantation and to assess the validity of company post-market clinical analysis. METHODS Authors analyzed a company based register of 6279 PHA cranioplasty implanted all over the world. In these adult patients only self-reported complications were available. We then obtained the data of adult patients treated with custom-made porous HA prostheses (CustomBone Service) in 20 institutions from different European countries through an on-site interview with the physicians in charge of the patients (494 patients). The endpoints were the incidence of adverse events and of related implant removal. RESULTS The groups of patients had similar demographics characteristics. The average follow-up was 26.7 months. A significantly higher number of complications was recorded in the group of patients underwent onsite interview. Thirty-nine complications were reported (7.89%) with an explantation rate of 4.25% (21 cases) in the series, compared to the data reported from the Company (complications rate of 3.3% and explantation rate of 3.1%). The most common complications were infection (4.86%), hematomas (1.22%), fractures (1.01%), mobilization (0.4%) and scar retraction (0.4%). CONCLUSIONS Our data confirm that porous HA cranioplasty is at least as effective as other heterologous materials to repair cranial defects. Another interesting finding is that self-reporting complicantions by surgeons does not give a precise picture of the real rate of complications of the devices. These data in future studies need to be re-confirmed with on-site interviews.
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Affiliation(s)
- Ismail Zaed
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy - .,Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy -
| | - Zefferino Rossini
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Francesca Faedo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco M Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Cardia
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Franco Servadei
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
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Liu L, Lu ST, Liu AH, Hou WB, Cao WR, Zhou C, Yin YX, Yuan KS, Liu HJ, Zhang MG, Zhang HJ. Comparison of complications in cranioplasty with various materials: a systematic review and meta-analysis. Br J Neurosurg 2020; 34:388-396. [PMID: 32233810 DOI: 10.1080/02688697.2020.1742291] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Meta-analysis to evaluate complications in the use of autogenous bone and bone substitutes and to compare bone substitutes, specifically HA, polyetheretherketone (PEEK) and titanium materials.Methods: Search of PubMed, Cochrane, Embase and Google scholar to identify all citations from 2010 to 2019 reporting complications regarding materials used in cranioplasty.Results: 20 of 2266 articles met the inclusion criteria, including a total of 2913 patients. The odds of overall complication were significantly higher in the autogenous bone group (n = 214/644 procedures, 33.2%) than the bone substitute groups (n = 116/436 procedures, 26.7%, CI 1.29-2.35, p < 0.05). In bone substitutes groups, there was no significant difference in overall complication rate between HA and Ti (OR, 1.2; 95% CI, 0.47-3.14, p = 0.69). PEEK has lower overall complication rates (OR, 0.51; 95% CI, 0.30-0.87, p = 0.01) and lower implant exposure rates (OR, 0.17; 95% CI, 0.06-0.53, p = 0.002) than Ti, but there was no significant difference in infection rates and postoperative hematoma rates.Conclusions: Cranioplasty is associated with high overall complication rates with the use of autologous bone grafts compared with bone substitutes. PEEK has a relatively low overall complication rates in substitutes groups, but still high infection rates and postoperative hematoma rates. Thus, autologous bone grafts should only be used selectively, and prospective long-term studies are needed to further refine a better material in cranioplasty.
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Affiliation(s)
- Liming Liu
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, China
| | - Shou-Tao Lu
- Tenth People's Hospital, Tongji University, Shanghai, China
| | - Ai-Hua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurointerventional Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen-Bo Hou
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, China
| | - Wen-Rui Cao
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, China
| | - Chao Zhou
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, China
| | - Yu-Xia Yin
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, China
| | - Kun-Shan Yuan
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, China
| | - Han-Jie Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming-Guang Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hai-Jun Zhang
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, China.,Tenth People's Hospital, Tongji University, Shanghai, China.,Faculty of Medicine, Aalborg University, Alborg, Denmark
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Policicchio D, Casu G, Dipellegrini G, Doda A, Muggianu G, Boccaletti R. Comparison of two different titanium cranioplasty methods: Custom-made titanium prostheses versus precurved titanium mesh. Surg Neurol Int 2020; 11:148. [PMID: 32637201 PMCID: PMC7332511 DOI: 10.25259/sni_35_2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to compare the results of two different titanium cranioplasties for reconstructing skull defects: standard precurved mesh versus custom-made prostheses. Methods: Retrospective analysis of 23 patients submitted to titanium cranioplasty between January 2014 and January 2019. Ten patients underwent delayed cranioplasty using custom-made prostheses; and 13 patients were treated using precurved titanium mesh (ten delayed cranioplasties, and three single-stage resection- reconstructions). Demographic, clinical, and radiological data were recorded. Results and complications of the two methods were compared, including duration of surgery, cosmetic results (visual analog scale for cosmesis [VASC]), and costs of the implants. Results: Complications: one epidural hematoma in the custom-made group, one delayed failure in precurved group due to wound dehiscence with mesh exposure. There were no infections in either group. All custom-made prostheses perfectly fitted on the defect; eight of 13 precurved mesh prostheses incompletely covered the defect. Custom-made cranioplasty obtained better cosmetic results (average VASC 94 vs. 68), shorter surgical time (141min vs. 186min), and -fewer screws was needed to fix the prostheses in place (6 vs. 15). However, satisfactory results were obtained using precurved mesh in cases of small defects and in single-stage reconstruction. Precurved mesh was found to be cheaper (€1,500 vs. €5,500). Conclusion: Custom-made cranioplasty obtained better results and we would suggest that this should be a first choice, particularly for young patients with a large cranial defect. Precurved mesh was cheaper and useful for single-stage resection-reconstruction. Depending on the individual conditions, both prostheses have their place in cranioplasty therapies.
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Affiliation(s)
- Domenico Policicchio
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola, Sassari, Italy
| | - Gina Casu
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola, Sassari, Italy
| | - Giosuè Dipellegrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola, Sassari, Italy
| | - Artan Doda
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola, Sassari, Italy
| | - Giampiero Muggianu
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola, Sassari, Italy
| | - Riccardo Boccaletti
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola, Sassari, Italy
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Surgical preference regarding different materials for custom-made allograft cranioplasty in patients with calvarial defects: Results from an internal audit covering the last 20 years. J Clin Neurosci 2020; 74:98-103. [DOI: 10.1016/j.jocn.2020.01.087] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
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Abstract
Custom made cranioplasty (CM CPL) represents the gold standard for cranial defect reconstruction, allowing an adequate protection of the brain with good cosmetic results. Nevertheless, it is an expensive procedure, requiring time for preparation of the prothesis. Aim of this study is to evaluate whether and in what cases handmade cranioplasty (HM CPL) still represents a valid alternative to CM CPL.Therefore, all consecutive cranioplasties in our center from 2013 to 2019 have been analyzed. Size and location of cranial defect have been considered, as the cause of decompression. Morbidity rate and final outcome have been evaluated. Series includes 143 patients (61% males, mean age: 60 years, SD:16). HM CPL was performed in 59 cases (41.2%) and CM in the remaining 84 (58.8%). HM CPL was preferred for smaller cranial defects (p: 0.22), inferior to 100 cm (p: 0.01) located in fronto-parietal-occipital area (p: 0.01). Furthermore, HM CPL results in the first choice after removal of infiltrative tumors (p: 0.02). Surgical complications consisted in 14 (9%) infections, 8 hematomas (5.6%), and one cranioplasty displacement (0.7%). At follow-up, in 85.3% of cases the CPL is still in place with satisfactory cosmetic and functional outcome (86.5% of HM CPL, 84.5% of CM CPL).HM CPL may still represent an effective and economic alternative procedure, when specific patient selection criteria are respected. This technique requires a long learning learning curve and demanding surgical maneuvers. Our handmade reconstruction technique with some hints to improve the esthetic result is presented.
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Spennato P, Canella V, Aliberti F, Russo C, Ruggiero C, Nataloni A, Lombardo M, Cinalli G. Hydroxyapatite ceramic implants for cranioplasty in children: a retrospective evaluation of clinical outcome and osteointegration. Childs Nerv Syst 2020; 36:551-558. [PMID: 31786632 DOI: 10.1007/s00381-019-04423-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cranioplasty in children is a controversial and challenging issue, since there is still no consensus on the ideal material. Main problems in paediatric age are represented by the child's growing skull, the lower bone thickness and the high incidence of cerebrospinal fluid (CSF) disorders or brain swelling. Autologous bone is still considered the "gold standard". When it is not available, a wide range of alloplastic materials have been proposed. Hydroxyapatite, a ceramic-based derivative, bears a chemical composition very similar to the human natural bone, making this material a valuable alternative to other cranioplasty solutions. METHODS All patients implanted with a custom-made porous hydroxyapatite device at Santobono-Pausilipon Hospital in Naples were retrospectively reviewed. A follow-up CT scan of the skull was performed from 1 up to 48 months postoperatively to document the bone ingrowth as well as the osteointegration process. The bone density was measured as according to the Hounsfield scale at the bone-implant interface. RESULTS Between 2014 and 2018, 11 patients (7 males, 4 females) underwent cranioplasty with hydroxyapatite ceramic implants (HAP). Patients' age ranged between 3 and 16 years old. Initial aetiology was trauma in most cases. Two subjects were implanted with HAP as primary cranioplasty, 9 as revision surgery following previous cranioplasty failure. Sites of the cranial defect were unilateral fronto-temporo-parietal (N = 8), unilateral frontal (N = 1) and bifrontal (N = 2). Two patients with large bilateral defects received two prostheses. In one of these, the two prostheses were explanted and replaced with two back-up implants (accounting for a total of 15 implants in 11 patients). Osteointegration was measurable for 12 out of 15 implanted devices. The mean percentage was about 51%. There were six asymptomatic prosthesis fractures (40%), all occurring within 6 months from implant. In one case, the bifrontal prostheses were explanted and replaced. This was the only patient who underwent revision surgery. CONCLUSION Hydroxyapatite ceramic implants represent a valid alternative to other cranioplasty solutions. Where coaptation occurs correctly, with good osteointegration, implant mechanical resistance increases over time.
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Affiliation(s)
- Pietro Spennato
- Department of Neurosurgery Santobono-Pausipilon children's hospital, Naples, Italy.
| | | | - Ferdinado Aliberti
- Department of Neurosurgery Santobono-Pausipilon children's hospital, Naples, Italy
| | - Carmela Russo
- Department of Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Claudio Ruggiero
- Department of Neurosurgery Santobono-Pausipilon children's hospital, Naples, Italy
| | | | - Milena Lombardo
- Department of Neurosurgery Santobono-Pausipilon children's hospital, Naples, Italy
| | - Giuseppe Cinalli
- Department of Neurosurgery Santobono-Pausipilon children's hospital, Naples, Italy
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Lewin S, Åberg J, Neuhaus D, Engqvist H, Ferguson SJ, Öhman-Mägi C, Helgason B, Persson C. Mechanical behaviour of composite calcium phosphate-titanium cranial implants: Effects of loading rate and design. J Mech Behav Biomed Mater 2020; 104:103701. [PMID: 32174441 DOI: 10.1016/j.jmbbm.2020.103701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Abstract
Cranial implants are used to repair bone defects following neurosurgery or trauma. At present, there is a lack of data on their mechanical response, particularly in impact loading. The aim of the present study was to assess the mechanical response of a recently developed composite calcium phosphate-titanium (CaP-Ti) implant at quasi-static and impact loading rates. Two different designs were tested, referred to as Design 1 (D1) and Design 2 (D2). The titanium structures in the implant specimens were additively manufactured by a powder-bed fusion process and subsequently embedded in a self-setting CaP material. D1 was conceptually representative of the clinically used implants. In D2, the titanium structure was simplified in terms of geometry in order to facilitate the manufacturing. The mechanical response of the implants was evaluated in quasi-static compression, and in impact using a drop-tower. Similar peak loads were obtained for the two designs, at the two loading rates: 808 ± 29 N and 852 ± 34 for D1, and 840 ± 40 N and 814 ± 13 for D2. A strain rate dependency was demonstrated for both designs, with a higher stiffness in the impact test. Furthermore, the titanium in the implant fractured in the quasi-static test (to failure) but not in the impact test (to 5.75 J) for D1. For D2, the displacement at peak load was significantly lower in the impact test than in the quasi-static test. The main difference between the designs was seen in the quasi-static test results where the deformation zones, i.e. notches in the titanium structure between the CaP tiles, in D1 likely resulted in a localization of the deformation, compared to in D2 (which did not have deformation zones). In the impact test, the only significant difference between the designs was a higher maximum displacement of D2 than of D1. In comparison with other reported mechanical tests on osteoconductive ceramic-based cranial implants, the CaP-Ti implant demonstrates the highest reported strength in quasi-static compression. In conclusion, the titanium structure seems to make the CaP-Ti implant capable of cerebral protection in impact situations like the one tested in this study.
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Affiliation(s)
- Susanne Lewin
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden.
| | - Jonas Åberg
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | | | - Håkan Engqvist
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | | | - Caroline Öhman-Mägi
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | | | - Cecilia Persson
- Div. of Applied Materials Science, Dept. of Engineering Sciences, Uppsala University, Uppsala, Sweden
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Morselli C, Zaed I, Tropeano MP, Cataletti G, Iaccarino C, Rossini Z, Servadei F. Comparison between the different types of heterologous materials used in cranioplasty: a systematic review of the literature. J Neurosurg Sci 2019; 63:723-736. [PMID: 31599560 DOI: 10.23736/s0390-5616.19.04779-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The choice of heterologous materials for cranioplasty after decompressive craniectomy is still difficult. The aim of this study is to examine the association between material of choice and related complications to suggest the best treatment option. EVIDENCE ACQUISITION A systematic review was performed for articles reporting cranioplasty comparing the following heterologous implants: titanium, poli-methyl-methacrylate (PMMA), polyetheretherketone (PEEK) and hydroxyapatite (HA). Extracted data included implant materials and incidence of the most frequent complications. EVIDENCE SYNTHESIS The final selection resulted in 106 papers but according to our rules only 27 studies were included in the final analysis. Among a total of 1688 custom-made prosthesis implanted, 649 were titanium (38.49%), 298 PMMA (17.56%), 233 PEEK (13.82%), and 508 were HA (30.13%). A total of 348 complications were recorded out of 1688 reported patients (20.64%). In the titanium group, 139 complications were recorded (21.42%); in the PMMA group 57 (19.26%), in the PEEK group 49 (21.03%) and in the HA group 103 (20.3%). If we examine a summary of the reported complications clearly related to cranioplasty (postoperative infections, fractures and prosthesis displacement) versus type of material in multicentric and prospective studies we can see how HA group patients have less reported infections and cranioplasty explantation after infections than PMMA, PEEK and titanium. On the contrary HA patients seem to have a higher number of prosthesis displacement again if compared with the other materials. Since these data are not derived from a statistically correct analysis they should be used only to help to differentiate the properties of the various heterologous cranioplasties. CONCLUSIONS The ideal material for all heterologous cranioplasty has not yet been identified. The choice of material should be based on the clinical data of patients, such as the craniectomy size, presence of seizures, possibility of recovery, good long-term outcome associated with a cost analysis.
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Affiliation(s)
- Carlotta Morselli
- Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Neuroscience, Sapienza University, Rome, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy -
| | | | | | - Corrado Iaccarino
- Department of Neurosurgery, University Hospital of Parma, Parma, Italy
| | - Zefferino Rossini
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
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Ganau M, Ligarotti GKI, Ganau L, Prisco L. Letter: Early Cranioplasty is Associated With Greater Neurological Improvement: A Systematic Review and Meta-Analysis. Neurosurgery 2019; 83:E87-E89. [PMID: 29846710 DOI: 10.1093/neuros/nyy205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mario Ganau
- Harvard Medical School Boston, Massachusetts.,School of Medicine University of Cagliari Cagliari, Italy
| | | | - Laura Ganau
- School of Medicine University of Cagliari Cagliari, Italy
| | - Lara Prisco
- John Radcliffe Hospital University of Oxford Oxford, United Kingdom
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Frassanito P, Massimi L, Tamburrini G, Bianchi F, Nataloni A, Canella V, Caldarelli M. Custom-made hydroxyapatite for cranial repair in a specific pediatric age group (7-13 years old): a multicenter post-marketing surveillance study. Childs Nerv Syst 2018; 34:2283-2289. [PMID: 29987377 DOI: 10.1007/s00381-018-3905-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND CustomBone Service (CBS) is a patient-specific, biocompatible, and osteoconductive device made of porous hydroxyapatite, indicated for cranial reconstruction in adults and children. Adult literature data report a failure rate of about 8%. The aim of this Post-Marketing Surveillance study is to verify the hypothesis that CBS in children aged 7-13 years old shows a failure rate not superior to adults. MATERIALS AND METHODS Inclusion criteria were age at implantation ranging 7-13 years old, with at least 1 year elapsed from the date of surgery. The degree of satisfaction of surgeons and patients was assessed. RESULTS Data about 76 implants in 67 patients (M:F = 41:26) were obtained from 28 centers across 7 European countries. The mean age at surgery was 10.03 ± 1.72 years, with age stratification almost equally distributed. Fifty-nine subjects received one CBS, 7 subjects two and one subject received three CBS. Main etiologies were trauma (60.5%), malformation (11.8%), bone tumor (10.5%), and cerebral tumor (7.9%). Main indications to CBS were decompression (47.4%), autologous bone resorption (18.4%), tumor resection (11.8%), malformation (9.2%), comminuted fracture (5.3%), and other materials rejection (5.3%). Main implantation sites were fronto-parieto-temporal (26.3%), parietal (23.7%), frontal (11.8%), fronto-temporal (10.5%), and parieto-temporal (7.9%). CBS was chosen as first line of treatment in 63.1% of the cases. Mean follow-up was about 36 months. Eleven adverse events (14.5%) were reported in nine devices. Five CBS required explantation (three cases of infection, one fracture, and one mobilization). Failure rate was 6.58%, which is statistically not superior to the explantation rate recorded in adults (two-sided 95%, CI 2.2-14.7%). Satisfaction of surgeons and patients was of about 95%. CONCLUSION CBS is a safe and effective solution for cranial repair in pediatric patients. In particular, over the age of 7, CBS shows a rate of failure as low as in adults.
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Affiliation(s)
- Paolo Frassanito
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Luca Massimi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federico Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Massimo Caldarelli
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
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Gelfoam Interposition Minimizes Risk of Fistula and Postoperative Bleeding in Modified-Furlow Palatoplasty. J Craniofac Surg 2018; 28:1993-1996. [PMID: 28437266 DOI: 10.1097/scs.0000000000003616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Failure to accomplish a tension-free, watertight closure predisposes the palatoplasty patient to fistula formation. Perioperative bleeding also places the patient at risk for adverse airway events (AAE). This study introduces the incorporation of a hemostatic gelatin sponge (Gelfoam) into layered palatoplasty to minimize adverse postoperative bleeding and fistula formation. A retrospective chart review was performed to identify subjects who underwent Furlow palatoplasty with insertion of Gelfoam from 2010 to 2015. Exclusion criteria include age >3 years, prior palate surgery, <30-day follow-up, immunosuppressive state, and diagnosis of Treacher-Collins or Apert Syndrome. Demographic data include age, sex, cleft laterality, prior surgeries, Veau classification, Pierre Robin status, and tracheostomy dependence. Primary outcome was fistula formation. Secondary outcomes included perioperative metrics and AAE.One hundred subjects met criteria, 45% female. Average age was 14.6 months. Subjects with syndromes comprised 28%, with 16% diagnosed with Pierre Robin. Two subjects were tracheostomy-dependent. Prior cleft and mandibular procedures were performed in 55%. Isolated palatal defects were seen in 46%, unilateral lip and palate in 41%, and bilateral lip and palate in 13%. The majority of defects were Veau II and III (35% and 34%, respectively). Adverse airway events occurred in 2%, one of which resulted in reintubation. One subject (1%) was found to have a postoperative fistula.The incorporation of Gelfoam in the modified-Furlow palatoplasty results in a low rate of oronasal fistula (1%) and low perioperative risk of AAE. Further prospective comparison of this method to others will be the focus of future work.
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Still M, Kane A, Roux A, Zanello M, Dezamis E, Parraga E, Sauvageon X, Meder JF, Pallud J. Independent Factors Affecting Postoperative Complication Rates After Custom-Made Porous Hydroxyapatite Cranioplasty: A Single-Center Review of 109 Cases. World Neurosurg 2018; 114:e1232-e1244. [PMID: 29625304 DOI: 10.1016/j.wneu.2018.03.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/24/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cranioplasties are an important neurosurgical procedure not only for improved cosmesis but also for improved functional recovery after craniectomy with a large cranial defect. The aim of this study was to identify predictive factors of postcranioplasty complications using custom-made porous hydroxyapatite cranioplasty. METHODS Retrospective review was performed of all patients who underwent a reconstructive cranioplasty using custom-made hydroxyapatite at our institution between February 2008 and September 2017. Postoperative complications considered included bacterial infection, seizures, hydrocephalus requiring ventricular shunt placement, and cranioplasty-to-bone shift. Variables associated at P < 0.1 level in unadjusted analysis were entered into backward stepwise logistic regression models. RESULTS Of 109 patients included, 15 (13.8%) experienced postoperative infection, with craniectomy performed at an outside institution (adjusted odds ratio [OR] 10.37 [95% confidence interval [CI], 2.03-75.27], P = 0.012) and a previous infection at the surgical site (adjusted OR 6.15 [95%CI, 1.90-19.92], P = 0.003) identified as independent predictors. Six patients (5.5%) experienced postoperative seizures, with stroke (ischemic and hemorrhagic) as a reason for craniectomy (adjusted OR 11.68 [95% CI, 2.56-24.13], P < 0.001) and the presence of seizures in the month before cranioplasty (adjusted OR 9.39 [95% CI, 2.04-127.67], P = 0.002) identified as independent predictors. Four patients (3.7%) experienced postcranioplasty hydrocephalus necessitating shunt placement, and 5 patients (4.6%) experienced cranioplasty-to-bone shift ≥5 mm, but no significant predictive factors were identified for either complication. CONCLUSIONS This study identified possible predictive factors for postcranioplasty complications to help identify at-risk patients, guide prophylactic care, and improve morbidity of this important surgical procedure.
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Affiliation(s)
- Megan Still
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Abdoulaye Kane
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Alexandre Roux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMABRAIN Team, Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Eduardo Parraga
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Xavier Sauvageon
- Department of Neuro-Anaesthesia and Neuro-Intensive Care, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Jean-François Meder
- Department of Neuroradiology, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMABRAIN Team, Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMABRAIN Team, Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France.
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Optimal Conditions for Absorbable Fixation of Hydroxyapatite Ceramic Implants. J Craniofac Surg 2017; 29:248-250. [PMID: 29287001 DOI: 10.1097/scs.0000000000004151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Synthetic hydroxyapatite (HAP) implants are common in craniofacial surgery; the major problem with HAP implants is fixation instability. An ultrasound-assisted pinned resorbable fixation system has recently been introduced. The authors hypothesized that this resorbable system could be used to fix HAP implants. The authors evaluated the optimal HAP porosity and resorbable pin using the pull-out test and microscopic analysis. Hydroxyapatite blocks were synthesized with 0% (dense type), 35% (fine pore type), and 50% (large pore type) porosity. Bioabsorbable pins of 4 sizes were tested: diameters of 1.6 or 2.1 mm and lengths of 4 or 7 mm. Among the 1.6 mm diameter pins, the 7-mm length pins showed higher pull-out strength (large pore, 6.5 ± 1.2 kgf; fine pore, 4.1 ± 0.7 kgf; dense, 2.4 ± 0.4 kgf) than the 4-mm length pins (large pore, 2.1 ± 1.0 kgf; fine pore, 1.3 ± 0.4 kgf; dense, 1.5 ± 0.9 kgf) with all 3 HAP types (P < 0.01). Among 2.1-mm diameter pins, all were removed from the large and fine pore HAP types without any resistance. Only three of seven 2.1 × 7 mm pins inserted into the dense type HAP showed pull-out strength (3.9 ± 2.1 kgf). Among all conditions, the 7-mm length, 1.6-mm diameter pin in large pore type HAP showed the highest pull-out strength. Microscopically, the large pore type HAP showed the liquefying pin flowing into the large pore adjacent to the pilot hole. By contrast, the fine pore and dense pore types of HAP did not allow flow, and the pins did not change in structure 3-dimensionally. The authors found that pull-out strength depends on HAP porosity, and pin length and diameter.
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Long-Term Follow-Up Comparative Study of Hydroxyapatite and Autologous Cranioplasties: Complications, Cosmetic Results, Osseointegration. World Neurosurg 2017; 111:e395-e402. [PMID: 29277595 DOI: 10.1016/j.wneu.2017.12.082] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE A three-dimensional reconstruction technique using the CustomBone (CB) prosthesis allows custom-made cranioplasty (CP) possessing osseointegration properties owing to its porous hydroxyapatite (HA) composition. This reconstruction technique has replaced less expensive techniques such as subcutaneously preserved autologous bone (SP). Our primary objective was to evaluate complications between CB and SP CP techniques. A secondary objective was to assess cosmetic results and osseointegration of CPs. METHODS This single-center study comprised patients undergoing delayed CB or SP CP after craniectomy between 2007 and 2014. A prospective interview was conducted to collect all data, including 2-year follow-up clinical and radiologic data. Cosmetic results were assessed by a qualitative score, and osseointegration was assessed by measuring relative fusion at the CP margins. RESULTS Of 100 patients undergoing CB or SP CP between 2007 and 2014, 92 (CB, n = 44; SP, n = 48) participated in the prospective interview. No significant difference in complication rates was observed between the 2 groups. The main complication specific to the CB group was fracture of the prosthesis observed in 20.8% patients. A higher rate of good cosmetic results was observed in the CB group (92.5% vs. 74.3%, P = 0.031). In the CB group, 51% of patients demonstrated no signs of bone fusion of the CP. CONCLUSIONS Although the CB prosthesis is associated with cosmetic advantages, the porous hydroxyapatite composition makes it fragile in the short-term and long-term, and effective osseointegration remains uncertain.
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Rathmann P, Chalopin C, Halama D, Giri P, Meixensberger J, Lindner D. Dynamic infrared thermography (DIRT) for assessment of skin blood perfusion in cranioplasty: a proof of concept for qualitative comparison with the standard indocyanine green video angiography (ICGA). Int J Comput Assist Radiol Surg 2017; 13:479-490. [PMID: 29143240 DOI: 10.1007/s11548-017-1683-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Complications in wound healing after neurosurgical operations occur often due to scarred dehiscence with skin blood perfusion disturbance. The standard imaging method for intraoperative skin perfusion assessment is the invasive indocyanine green video angiography (ICGA). The noninvasive dynamic infrared thermography (DIRT) is a promising alternative modality that was evaluated by comparison with ICGA. METHODS The study was carried out in two parts: (1) investigation of technical conditions for intraoperative use of DIRT for its comparison with ICGA, and (2) visual and quantitative comparison of both modalities in a proof of concept on nine patients. Time-temperature curves in DIRT and time-intensity curves in ICGA for defined regions of interest were analyzed. New perfusion parameters were defined in DIRT and compared with the usual perfusion parameters in ICGA. RESULTS The visual observation of the image data in DIRT and ICGA showed that operation material, anatomical structures and skin perfusion are represented similarly in both modalities. Although the analysis of the curves and perfusion parameter values showed differences between patients, no complications were observed clinically. These differences were represented in DIRT and ICGA equivalently. CONCLUSIONS DIRT has shown a great potential for intraoperative use, with several advantages over ICGA. The technique is passive, contactless and noninvasive. The practicability of the intraoperative recording of the same operation field section with ICGA and DIRT has been demonstrated. The promising results of this proof of concept provide a basis for a trial with a larger number of patients.
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Affiliation(s)
- P Rathmann
- Innovation Center Computer Assisted Surgery (ICCAS), University Leipzig, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - C Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), University Leipzig, Semmelweisstraße 14, 04103, Leipzig, Germany.
| | - D Halama
- Oral and Maxillofacial Surgery Department, University Hospital Leipzig, Liebigstraße 12, 04103, Leipzig, Germany
| | - P Giri
- Innovation Center Computer Assisted Surgery (ICCAS), University Leipzig, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - J Meixensberger
- Department of Neurosurgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - D Lindner
- Department of Neurosurgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Use of a three-dimensional custom-made porous titanium prosthesis for mandibular body reconstruction. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lee JC, Volpicelli EJ. Bioinspired Collagen Scaffolds in Cranial Bone Regeneration: From Bedside to Bench. Adv Healthc Mater 2017; 6:10.1002/adhm.201700232. [PMID: 28585295 PMCID: PMC5831258 DOI: 10.1002/adhm.201700232] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/11/2017] [Indexed: 12/24/2022]
Abstract
Calvarial defects are common reconstructive dilemmas secondary to a variety of etiologies including traumatic brain injury, cerebrovascular disease, oncologic resection, and congenital anomalies. Reconstruction of the calvarium is generally undertaken for the purposes of cerebral protection, contour restoration for psychosocial well-being, and normalization of neurological dysfunction frequently found in patients with massive cranial defects. Current methods for reconstruction using autologous grafts, allogeneic grafts, or alloplastic materials have significant drawbacks that are unique to each material. The combination of wide medical relevance and the need for a better clinical solution render defects of the cranial skeleton an ideal target for development of regenerative strategies focused on calvarial bone. With the improved understanding of the instructive properties of tissue-specific extracellular matrices and the advent of precise nanoscale modulation in materials science, strategies in regenerative medicine have shifted in paradigm. Previously considered to be simple carriers of stem cells and growth factors, increasing evidence exists for differential materials directing lineage specific differentiation of progenitor cells and tissue regeneration. In this work, we review the clinical challenges for calvarial reconstruction, the anatomy and physiology of bone, and extracellular matrix-inspired, collagen-based materials that have been tested for in vivo cranial defect healing.
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Affiliation(s)
- Justine C Lee
- Greater Los Angeles Veterans Affairs Research Service, Los Angeles, California
- University of California Los Angeles Division of Plastic and Reconstructive Surgery, Los Angeles, California
| | - Elizabeth J Volpicelli
- Greater Los Angeles Veterans Affairs Research Service, Los Angeles, California
- University of California Los Angeles Division of Plastic and Reconstructive Surgery, Los Angeles, California
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Jiang J, Marathe AR, Keene JC, Taylor DM. A testbed for optimizing electrodes embedded in the skull or in artificial skull replacement pieces used after injury. J Neurosci Methods 2017; 277:21-29. [PMID: 27979758 PMCID: PMC5253247 DOI: 10.1016/j.jneumeth.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 12/06/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Custom-fitted skull replacement pieces are often used after a head injury or surgery to replace damaged bone. Chronic brain recordings are beneficial after injury/surgery for monitoring brain health and seizure development. Embedding electrodes directly in these artificial skull replacement pieces would be a novel, low-risk way to perform chronic brain monitoring in these patients. Similarly, embedding electrodes directly in healthy skull would be a viable minimally-invasive option for many other neuroscience and neurotechnology applications requiring chronic brain recordings. NEW METHOD We demonstrate a preclinical testbed that can be used for refining electrode designs embedded in artificial skull replacement pieces or for embedding directly into the skull itself. Options are explored to increase the surface area of the contacts without increasing recording contact diameter to maximize recording resolution. RESULTS Embedding electrodes in real or artificial skull allows one to lower electrode impedance without increasing the recording contact diameter by making use of conductive channels that extend into the skull. The higher density of small contacts embedded in the artificial skull in this testbed enables one to optimize electrode spacing for use in real bone. COMPARISON WITH EXISTING METHODS For brain monitoring applications, skull-embedded electrodes fill a gap between electroencephalograms recorded on the scalp surface and the more invasive epidural or subdural electrode sheets. CONCLUSIONS Embedding electrodes into the skull or in skull replacement pieces may provide a safe, convenient, minimally-invasive alternative for chronic brain monitoring. The manufacturing methods described here will facilitate further testing of skull-embedded electrodes in animal models.
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Affiliation(s)
- JingLe Jiang
- Department of Neurosciences, The Cleveland Clinic, Cleveland, OH 44195, United States; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Cleveland Functional Electrical Stimulation (FES) Center of Excellence, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States
| | - Amar R Marathe
- Department of Neurosciences, The Cleveland Clinic, Cleveland, OH 44195, United States; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Cleveland Functional Electrical Stimulation (FES) Center of Excellence, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States; Human Research and Engineering Directorate, US Army Research Laboratory, Aberdeen Proving Ground, MD 21005, United States
| | - Jennifer C Keene
- Department of Neurosciences, The Cleveland Clinic, Cleveland, OH 44195, United States; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Cleveland Functional Electrical Stimulation (FES) Center of Excellence, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States
| | - Dawn M Taylor
- Department of Neurosciences, The Cleveland Clinic, Cleveland, OH 44195, United States; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Cleveland Functional Electrical Stimulation (FES) Center of Excellence, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States.
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Scalp Tissue Expansion Above a Custom-Made Hydroxyapatite Cranial Implant to Correct Sequelar Alopecia on a Transposition Flap. World Neurosurg 2016; 95:616.e1-616.e5. [DOI: 10.1016/j.wneu.2016.08.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/23/2016] [Accepted: 08/26/2016] [Indexed: 11/17/2022]
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