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De Benedictis A, Sawant N, Marasi A, Rossi-Espagnet MC, Carai A, Luglietto D, Bua A, Randi F, Savioli A, Borro L, Zama M, Marras CE. Calcium phosphate and titanium cranioplasty after total angular craniopagus separation. Clin Neurol Neurosurg 2023; 232:107906. [PMID: 37482050 DOI: 10.1016/j.clineuro.2023.107906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
Craniopagus separation requires careful planning and a multi-staged surgical approach, managed by a multidisciplinary team. Despite growing experience on surgical management, the long-term restoration of the cranial defect has been rarely discussed so far. Several alloplastic materials have been proposed as effective and safe solutions for cranioplasty even for pediatric patients, allowing for bone generation, good aesthetic results, and low complication rates. We report, for the first time, on a separated craniopagus child who underwent successful implant of a tailor-made system based on the combination of calcium phosphate ceramic reinforced with a titanium mesh.
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Affiliation(s)
- Alessandro De Benedictis
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy.
| | - Ninad Sawant
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Alessandra Marasi
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
| | | | - Andrea Carai
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
| | - Davide Luglietto
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
| | - Antonella Bua
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
| | - Alessandra Savioli
- Intensive Care Unit, Bambino Gesù Children's Hospital IRCCS, 4, piazza S. Onofrio, 00165 Rome, Italy
| | - Luca Borro
- Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofrio, 00165 Rome, Italy
| | - Mario Zama
- Craniofacial Centre-Plastic and Maxillofacial Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofrio, 00165 Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 4, piazza S. Onofriovb, 00165 Rome, Italy
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Cerveau T, Rossmann T, Clusmann H, Veldeman M. Infection-related failure of autologous versus allogenic cranioplasty after decompressive hemicraniectomy - A systematic review and meta-analysis. Brain Spine 2023; 3:101760. [PMID: 37383468 PMCID: PMC10293301 DOI: 10.1016/j.bas.2023.101760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/30/2023]
Abstract
Introduction Cranioplasty is required after decompressive craniectomy (DC) to restore brain protection and cosmetic appearance, as well as to optimize rehabilitation potential from underlying disease. Although the procedure is straightforward, complications either caused by bone flap resorption (BFR) or graft infection (GI), contribute to relevant comorbidity and increasing health care cost. Synthetic calvarial implants (allogenic cranioplasty) are not susceptible to resorption and cumulative failure rates (BFR and GI) tend therefore to be lower in comparison with autologous bone. The aim of this review and meta-analysis is to pool existing evidence of infection-related cranioplasty failure in autologous versus allogenic cranioplasty, when bone resorption is removed from the equation. Materials and methods A systematic literature search in PubMed, EMBASE, and ISI Web of Science medical databases was performed on three time points (2018, 2020 and 2022). All clinical studies published between January 2010 and December 2022, in which autologous and allogenic cranioplasty was performed after DC, were considered for inclusion. Studies including non-DC cranioplasty and cranioplasty in children were excluded. The cranioplasty failure rate based on GI in both autologous and allogenic groups was noted. Data were extracted by means of standardized tables and all included studies were subjected to a risk of bias (RoB) assessment using the Newcastle-Ottawa assessment tool. Results A total of 411 articles were identified and screened. After duplicate removal, 106 full-texts were analyzed. Eventually, 14 studies fulfilled the defined inclusion criteria including one randomized controlled trial, one prospective and 12 retrospective cohort studies. All but one study were rated as of poor quality based on the RoB analysis, mainly due to lacking disclosure why which material (autologous vs. allogenic) was chosen and how GI was defined. The infection-related cranioplasty failure rate was 6.9% (125/1808) for autologous and 8.3% (63/761) for allogenic implants resulting in an OR 0.81, 95% CI 0.58 to 1.13 (Z = 1.24; p = 0.22). Conclusion In respect to infection-related cranioplasty failure, autologous cranioplasty after decompressive craniectomy does not underperform compared to synthetic implants. This result must be interpreted in light of limitations of existing studies. Risk of graft infection does not seem a valid argument to prefer one implant material over the other. Offering an economically superior, biocompatible and perfect fitting cranioplasty implant, autologous cranioplasty can still have a role as the first option in patients with low risk of developing osteolysis or for whom BFR might not be of major concern. Trial registration This systematic review was registered in the international prospective register of systematic reviews. PROSPERO: CRD42018081720.
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Affiliation(s)
- Tiphaine Cerveau
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Tobias Rossmann
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael Veldeman
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
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