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PubMed2004

A cheap technical solution for cranioplasty treatments.

Skull defects are treated by cranioplasty techniques, which are required to protect underlying brain, correct major aesthetic deformities, or both. This research is a part of our research project in ASEAN countries to investigate (i) the methods for design and manufacturing of cranioplasty implants, and (ii) the feasible technical solutions of minimizing the implant cost based on available production and biomaterial technologies in the region. In this paper, solutions for design and manufacturing of standardized implant templates (SDT) are presented. SDT are made based on the reverse engineering and rapid tooling techniques. With the use of SDT, surgeons have flexible options in preparing the implant both pre and intra operatively, and the operation time is minimized. In addition, the skills required to prepare an implant from SDT are not highly required. The cost for cranioplasty treatments by using SDT is acceptable for ASEAN region.

Computer-Aided Design↗
PubMed2006

[A simple and accurate technique for cranioplasty in skull tumor surgery].

Cranioplasty using methylmethacrylate is a common method in patients with cranial defects. However, it is often difficult to precisely restore a removed cranium. The authors developed a new technique of cranioplasty. In the present study, we first made a cast composed of methylmethacrylate using a bone flap. We then covered the cast with a sheet of wet gauze. The implant was made by applying methylmethacrylate cement onto the gauze. The implant is firmly fixed to the cranium with titanium plates. Five cranioplasties were perfomed using this new technique. All patients achieved excellent cosmetic results with no complications. This technique enables low-cost, easy and cosmetically successful cranioplastic surgery.

Adult↗
PubMed1991

The use of bone grafts and alloplastic materials in cranioplasty.

Trephination dates from prehistoric neolithic times (10,000-7000 B.C.) and is the oldest operation known. Cranioplasty with bone allografts dates from the Stone Age Celts. Through the millennia, generations of surgeons have tried bone autografts, allografts, and rarely xenografts for cranioplasty but abandoned these in favor of alloplastic metals and plastics, most recently methylmethacrylate. Disillusionment with bone cranioplasty has followed the recurrent experience that orthotopic transplantation of bone to skull is almost invariably accompanied by a striking propensity for resorption. Resorption coupled to new bone formation is the usual process of remodeling. A unique acellular nonosteoclastic resorption, antedating invasion of the graft by osteoprogenitor cells and unrelated to the remodeling, characterizes the initial response of bone placed in a skull bed. This previously undescribed resorption in the skull likely represents passive diffusion of mineral from an altered matrix (calciolysis) and varies directly with the degree the graft is denatured by processing. There is the least amount of resorption in the fresh autograft and the most in autoclaved or chemically treated frozen or freeze-dried grafts. Remodeling of this diminished template occurs centripetally from skull defect margins through osteoconductive mechanisms only. Marrow-poor skull with thin diploe provides few osteoprogenitor cells that slowly, incompletely remodel the reduced graft over years.

Biocompatible Materials↗
PubMedDate not supplied

Gas bubbles in polymethylmethacrylate cranioplasty simulating abscesses: CT appearance.

Polymethylmethacrylate (PMMA) cranioplasty procedures were performed on 20 patients over a 2-year period. Nine of these patients had a total of 17 CT examinations, performed when clinically indicated. On 16 of the 17 CT scans, the appearance of the cranioplasty plate was characteristic of plates with gas bubbles. The appearance of these bubbles was stable over an extended period of time, ruling out clinical reasons for this appearance. The original interpretations of the CT scans were variable, inconclusive, or even erroneous. An understanding of the application of PMMA plates and their characteristics is necessary to accurately interpret the CT appearance of the PMMA cranioplasty plate.

Abscess↗
PubMed1997

[The history of cranioplasty].

Cranioplasties were first performed at the dawn of the history of medicine, as they usually constitute the repair phase of trephination. In preColumbian civilizations, they usually consisted of simple interposition of metal sheets under the scalp. Hippocrates and especially Galien prohibited this surgery and their principles were respected until the 18th century, although a remarkable surgeon, Van Meekeren, succeeded in performing a heterologous cranial bone graft from dog to man in 1668. The discovery of the osteogenic role of periosteum by Duhamel in 1742 opened the way to new research. During the 19th century, there was an extraordinary growth of science, during which all of the bases of the modern medical approach were established. For example, the studies by Ollier in 1859 allowed the first cranial reconstructions by heterologous, homologous and autologous bone transfers. The large number of head injuries left by the First World War promoted the growth of bone cranioplasties, as shown by Delagénière. The discovery of antibiotics allowed the reintroduction of cranioplasties using inert materials such as acrylic resins. However, their excessive use was complicated by numerous cases of infectious rejection. At the end of the 20th century, microsurgery and molecular biology have provided solutions, but have still not resolved the dilemma between reconstructions by autologous or foreign materials.

Animals↗
PubMedDate not supplied

Cranioplasty with a silicone prosthesis and split rib grafts.

A method to reconstruct visible cranioplasty defects involving the anterior cranium with the durability of bone and the exacting contours of the custom silicone implant is described. This technique is simple, quick, and does not require intraoperative assessment of subtle contours. The patient has a rigid underlying bony support with a perfectly contoured external surface. In patients with cranioplasty involving the cranium anterior to the hairline, we take advantage of both split rib grafts and a silicone prosthesis in one stage to obtain optimal results.

Adult↗
PubMed2005

Taylored implants for alloplastic cranioplasty--clinical and surgical considerations.

Traumatic loss of bone substance or post - decompression defects require the reconstruction of the skull. In cases of simple geometry there are handy, secure and cost effective procedures such as using autologuous cryopreserved bone flaps or polymerized Methylmethacrylat. For large sized defects CAD - taylored implants developed to provide a comfortable procedure to ensure high biocompatibility and perfect anatomical results by one - stage surgery. Furthermore cranioplasty does not only imply anatomical reconstruction but also functional recovery of awareness, cognition and motoric functions as shown in several studies according to changes in cerebral hemodynamics and metabolism. In our series of 286 patients who underwent cranioplasty during the past 10 years (1993-2003) we used taylored implants in 15 cases starting in 1999. All the patients included showed large sized defects > 64 cm2, complications did not occur neither during surgery nor the postoperative course, cosmetical results were excellent in all the patients. Neurological findings and the functional state improved in 11/15 patients, 4/15 patients showed no change, nevertheless these patients had reached a good recovery before surgery. Application of this technique is limited by cost, nonetheless it is recommended for extensive reconstruction of the skull.

Adult↗
PubMed1992

Expanding cranioplasty for craniosynostosis and allied disorders.

For early correction of craniosynostosis in the newborn or in early infancy, strip craniectomy may produce satisfactory results. For late correction, however, more radical cranial reconstruction procedures are essential in order to achieve adequate remodeling of cranial deformities and normalization of intracranial pressure. Craniosynostosis presents various types of cranial deformity, and different procedures for its correction have been reported. Expanding cranioplasty is presented for the increase of cranial volume and immediate correction of the cranial deformity. This cranioplasty can be applied not only for late correction of various types of craniosynostosis but also for other cranial deformities.

Craniosynostoses↗
PubMed1980

Cranioplasty utilizing a preserved autogenous bone flap coated with acrylic resin.

Cranioplasty utilizing a resin-coated preserved autogenous skull flap was devised and used in 36 cases, 14 of them being followed up radiologically. It has been confirmed that this method is advantageous in that it repairs the skull defect satisfactorily both from surgical and cosmetic points of view. Furthermore this method causes no anxiety to the patient because of the autogenous origin of the bone flap. We recommend this method for cranioplasty when an autogenous bone flap is preserved.

Adolescent↗
PubMed1990

Cranioplasty with a frozen and autoclaved bone flap.

27 cases of cranioplasty with autogenous bone grafts stored in a deep-freezer and autoclaved before use are reported. The results of follow-up for an average period of one year were satisfactory from the standpoint of brain protection and cosmetic reconstruction. A small area of absorption of grafted bone was observed in two cases on the follow-up skull roentgenograms. No serious complications were seen except in one case, whose bone flap had to be removed due to an epidural abscess. Experiments revealed that deep-freezing and autoclaving had only minimal effects on bone structure, although osteocytes degenerated. Autogenous bone flap after deep-freezing is a useful material for cranioplasty but sterilization before use is indispensable. Autoclaving is a simple method for sterilization of the flap, available in any operating theatre. It does not increase the risk of postoperative complications such as infection or absorption.

Adult↗
PubMed2006

Expansile cranioplasty for massive occipital encephalocele.

OBJECTIVE: This report highlights the management of infrequently encountered massive occipital encephaloceles with herniation of large amount of apparently functional cortex into the encephalocele sac. MATERIALS AND METHODS: Two children with giant occipital encephaloceles with herniation of significant brain parenchyma into the encephalocele sac were managed with expansile cranioplasty and reconstruction of the calvarial defect with autologus bone graft harvested from the adjacent parietal region. CONCLUSIONS: Giant occipital encephaloceles with significant brain parenchyma in the encephalocele sac can be considered for preservation of the herniated parenchyma and expansile cranioplasty.

Bone Transplantation↗
PubMed1998

Two different surgical techniques for reduction cranioplasty.

Reduction cranioplasty is required in selected patients when macrocephaly interferes with head control, seating, locomotion, and social acceptance. Two different surgical techniques for reduction cranioplasty in two cases of older hydrocephalic patients are described. Emphasis is placed on the basic stages of the procedure.

Cerebrospinal Fluid Shunts↗
PubMed2005

Clinical evaluation of the polypropylene-polyester knit used as a cranioplasty material.

UNLABELLED: The paper presents clinical evaluation of the polypropylene-polyester knit used as a cranioplasty material. MATERIAL: Between year 1980 and 2002 275 cranioplastic procedures using the polypropylene-polyester plates Codubix were carried out in the Department of Neurosurgery of the Medical University of Łódź. There were 146 patients who primarily sustained head injuries and 129 non-traumatic patients with craniectomies carried out for various other reasons. In the majority of cases, i.e. in 158 patients, cranioplasty was performed later than 6 months after the primary surgery. The largest implant measured 430 cm2. RESULTS: Excellent and good outcome was achieved in 92% of the patients whereas the rate of local infection was 8%. CONCLUSIONS: Codubix knitted polypropylene-polyester implant proved to be useful and a safe cranioplastic material.

Adolescent↗
PubMed2006

Analyses of the factors influencing bone graft infection after delayed cranioplasty.

BACKGROUND: Several factors influencing bone graft infection after delayed cranioplasty are analyzed in order to reduce the occurrence of infection. METHODS: For about 10 years, from March 1995 to February 2005, delayed cranioplasty was performed for 206 cases. The cases comprised 124 males and 82 females. Age distribution of the patients ranged from 6 months to 79 years old. The mean postoperative follow-up period was 1834 days. Autogenous bone, which was preserved in 100% ethanol at -20 degrees C and autoclaved before operation, was used in 54 patients. Polymethylmethacrylate (PMMA) was used in 55 patients. Custom-made PMMA was used in 3 patients. Custom-made titanium mesh was used in 77 patients. Custom-made ceramics (Alumina-ceramics 10 cases and hydroxyapatite 7 cases) was used in 17 patients. FINDINGS: Autoclaved and autogenous bone graft and PMMA have a significantly high rate of graft infection. Titanium mesh has the significantly lowest rate of graft infection. Alumina-ceramic has a merit that it has sufficient strength, however the number of cases using custom-made ceramics including alumina-ceramic was relatively small, and thus we cannot find significant differences in infection rate compared with that of other materials. There was no statistically significant difference in the bone graft infection rate among four categories of preceding diseases; cerebrovascular diseases, head trauma, infectious diseases, and brain tumour. CONCLUSION: Autoclaved and autogenous bone grafts and PMMA have a significantly higher rate of graft infection. Titanium mesh has the significantly lowest rate of graft infection.

Adolescent↗
PubMed2004

A simple technique for expansive suboccipital cranioplasty following foramen magnum decompression for the treatment of syringomyelia associated with Chiari I malformation.

The benefits of osteoplastic suboccipital craniotomies over the traditional suboccipital craniectomies have been recognized. We describe a simple method of expansive suboccipital cranioplastic craniotomy using a free bone flap and report satisfactory clinical results in 16 patients with syringomyelia associated with Chiari I malformation. A free suboccipital bone flap is created from the rostral part of the occiput by placing two to four burr holes and connecting them with a craniotome. The posterior bony margin of the foramen magnum and the posterior arch of C1 are removed thereafter. Then dural plasty using a patch graft of dural substitutes is performed. The expansive suboccipital cranioplasty is performed by positioning the free bone flap caudal to the original location and fixing it with titanium miniplates to construct a bony frame to cover the foramen magnum. The rostral part of the cranial defect is filled with bone chips created during the craniotomy. Sixteen patients underwent this procedure. There was no operative mortality and no major complication, such as persistent pseudomeningocele. Preoperative symptoms improved significantly in all patients except for one who had persistent dysesthetic pain. Our simple method of expansive suboccipital cranioplasty for the treatment of syringomyelia associated with Chiari I malformation proved useful and achieved satisfactory long-term results.

Adolescent↗
PubMed2006

Performance of functionally graded implants of polylactides and calcium phosphate/calcium carbonate in an ovine model for computer assisted craniectomy and cranioplasty.

Biodegradable functionally graded skull implants on the basis of polylactides and calcium phosphate/calcium carbonate were prepared in an individual mould using a combination of different processing techniques. A geometrically corresponding resection template was designed to enable a craniectomy and cranioplasty with the prepared implant in the same operation. After various preliminary experiments concerning degradation kinetics, pH evolution during degradation, micromorphology, biocompatibility tests in human osteoblast cell cultures and surgery of cadaver heads, a new large-animal model was developed for long-term in vivo studies. In eight 12-months-old sheep, the surgical templates were used to create 4.5 x 5 cm(2) calvarial defects which were then filled with the corresponding degradable implants in the same operation. The animals were sacrificed after 2, 9, 12 and 18 months, and the implants and the surrounding tissues were analysed by computer tomography (CT), macroscopic examination and microscopy. The new animal model proved to be reliable and very suitable for large individual craniectomies and cranioplasties. The formation of new bone from the dural layer of the meninges corresponded well to the degradation of the porous inner layer of the implants whereas the skull contour was stabilised by the compact outer layer over the follow-up period.

Animals↗
PubMed2004

Prospective study on cranioplasty with individual carbon fiber reinforced polymer (CFRP) implants produced by means of stereolithography.

BACKGROUND: The aim of this study was to evaluate the value of carbon fiber reinforced polymer (CFRP) cranial implants produced by means of 3-dimensional (3D) stereolithography (SL) and template modeling for reconstructions of complex or extensive cranial defects. PATIENTS: A series of 41 cranioplasties with individual CFRP implants was performed in 37 patients between April 1996 and November 2002. Only patients with complex and/or large cranial defects were included, most of them having extended scarring or dural calcification and poor quality of the overlying soft-tissue cover after infection or multiple preceding operations. Involvement of frontal sinus, a known risk factor for complications after cranioplasty, was the case in 21 patients (51.2%). METHODS: A computer-based 3D model of the skull with the bony defect was generated by means of stereolithography after acquisition, evaluation and transfer of the patient's helical computed tomography (CT) data. A wax template of the defect that was used to design the individual prosthesis-shape was invested in dental stone. Then, the cranial implant was fabricated out of CFRP by loosen mold. RESULTS: Reconstruction of defects measuring up to 17 x 9 cm was performed. The intra-operative fit of the implants was excellent in 36 (87.8%), good in 1 (2.4%), and fair in 4 (9.8%) of the cases. Problems of implant fit occurred because of extended scarring and poor quality of soft-tissue cover. Adverse reactions were observed in 5 patients (1 subdural, 1 subcutaneous hematoma, 2 infections, 1 allergic reaction). Excellent contours and a solid stable reconstruction have been maintained in 30 out of 35 remaining plates (mean follow-up 3.6 years). No adverse effects concerning postoperative imaging, the accuracy of electroencephalograms and radiation therapy have been observed. CONCLUSIONS: The authors believe that this relatively new technique represents an advance in the management of complex and large cranial defects, but seems less suitable for simple defects because of cost-intensive techniques. Because of the high mechanical strength, biocompatibility, innovative design, and especially radiolucency, CFRP implants should, however, be considered in smaller defects if further imaging investigations or irradiation therapies are necessary.

Adult↗
PubMedDate not supplied

Experimental cranioplasty and skeletal augmentation using an alpha-tricalcium phosphate/dicalcium phosphate dibasic/tetracalcium phosphate monoxide cement: a preliminary short-term experiment in rabbits.

Calcium phosphate cement consisting of alpha-tricalcium phosphate (alpha-TCP), dicalcium phosphate dibasic (DCPD) and tetracalcium phosphate monoxide (TeCP) was implanted into surgically created full-thickness defects in the cranial bone (bone defect experiment) and directly onto the cranial bone under the periosteum (augmentation experiment). Three months after the implantation, the implants were retrieved with the surrounding tissues and studied histologically and micrographically to evaluate if the cement can be used as a cranioplasty and skeletal augmentation material. In the bone defect experiment, successful reconstruction of the defect was seen in 8 out of 12 specimens. Four specimens, where bleeding control was difficult at the time of implantation, showed partial loss of the cement. Histological and microradiographic studies of the successfully implanted cement revealed that new bone surrounded the implant nearly completely and united directly with the cement surface. In the augmentation experiment, the augmented area maintained the hemispherical shape and was connected tightly with the host bone. Histology and microradiography demonstrated that new bone formation was seen in the gap between the cement and the host bone, and on the outer surface (periosteum side) of the cement at the edge of the implant. From this preliminary short-term study, it could be concluded that the cement is a promising material for cranioplasty and skeletal augmentation with indications that it has good osteoconductivity.

Animals↗