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PubMed1998

A method of cranioplasty using coralline hydroxyapatite.

INTRODUCTION: Current cranioplasty materials include autologous or homologous bone grafts, wire mesh and methyl methacrylate, either alone or in combination. However, each material has its own unique disadvantages. Although hydroxyapatite has been used extensively in other specialties as a bone substitute, the coralline form has rarely been used to repair cranial bone defects. Coralline hydroxyapatite, similar to that found in bone, provides a matrix on which living tissue can form and grow. Because it is an ideal bioimplant, a method of cranioplasty using coralline hydroxyapatite was employed. METHODS: The hydroxyapatite granules are mixed with Avitene and autologous blood to form a paste which can be contoured as needed. RESULTS: Over the past few years, we have used hydroxyapatite either alone or in combination with tantalum mesh in 19 pediatric patients for a variety of conditions. The cosmetic results were good to excellent. Furthermore, postoperative CT scans have documented bony substitution of the hydroxyapatite granules. Follow-up ranged from 1 to 43 months with a mean of 26 months. CONCLUSION: In neurosurgical procedures when a bone substitute is needed, hydroxyapatite is an effective alternative to other currently available materials.

Bone Substitutes↗
PubMed1988

Allogeneic fetal bone cranioplasty in Macaca mulatta.

Teratogen-induced herniation of the occipital lobes (encephalocele) associated with cranium bifidum in monkey fetuses (Macaca mulatta) were repaired by amputation and cranioplasty in utero or postnatally. Fetal allogeneic cranial bone which had been fresh frozen was used in conjunction with a bone paste to provide a protective covering of the neural tissue following repair of the encephalocele. The bone graft in those animals treated in utero or 1-2 weeks post-partum developed a strong union with the calvarium, provided good protection for the underlying dura and neural tissue, had a smooth surface, and provided good cosmetic-reconstructive results. In contrast, when the cranioplasty procedure was performed on infant monkeys at 2-3 months of age the bone graft was rejected.

Age Factors↗
PubMed2001

Reduction cranioplasty for craniocerebral disproportion due to chronic subdural hematoma in infants. A technical report.

Advanced craniocerebral disproportion due to chronic subdural hematoma in infants which is resistant to conventional treatments requires reduction cranioplasty as the last resort. The present paper deals with our experience with two such cases originated from head injury. Since the volume of the hematoma cavity was calculated based on the pre-operative CT scans, we devised a mathematical formula to design how the cranial vault could be reconstructed for reduction. This enabled us to pre-determine the extent of cranial reduction which was tailored to each patient. Furthermore, the present methodology is characterized by the modification that the midline bone strip overlying the superior sagittal sinus was shortened at its anterior end and bent down using the posterior end as a hinge. Since the follow-up results were favorable, this technique of reduction cranioplasty is reported in detail.

Cerebral Cortex↗
PubMed1979

Autogenous skull cranioplasty: fresh and preserved (frozen), with consideration of the cellular response.

Every craniotomy requires immediate replacement of a fresh autograft of skull or, in the presence of cerebral swelling, delayed reimplantation of preserved autogenous skull. Resumption of osteogenesis, the index of viability, determines the effectiveness of these segments of calvaria in protecting the brain and restoring skull conformity. The cellular response in skull replaced either at the end of craniotomy or after frozen preservation was studied by light and fluorescence microscopy, skull roentgenograms, and radionuclide scintigraphy. In 5 patients eventual total remodeling of skull was found at the time of a second craniotomy performed from 1 to 19 years after the first. In 12 patients skull sections removed aseptically at craniotomy were frozen and stored for 1 to 35 months at -20 degrees C in bacitracin. This cytotoxic preservative method fixed the tissue, which appeared unchanged on light microscopy and was sterile on bacteriological and fungal cultures. In 53 patients who underwent autogenous cranioplasty with skull stored frozen for 3 weeks to 19 months, 48 operations were totally successful. Complications included infections in 2 patients, resorption in 2 infants, and incomplete restoration in 1 adult. In 10 patients the sequential dynamics of skull revitalization were found to be: revascularization, resorption, and accretion. The repair of membranous skull is similar to that of endochondral bone of the skeleton. Skull is metabolically intensely active after reimplantation and is the ideal material for cranioplasty.

Adolescent↗
PubMed2003

Cranioplasty by means of molded polymethylmethacrylate prosthetic reconstruction after radical excision of neoplasms of the skull in two dogs.

Two dogs with osteoma or multilobulated tumor of bone of the skull were treated with large en bloc resections. The resections resulted in exposure of the brain above the horizon line of the remaining calvarium; in 1 dog, the removal of the dorsal orbital rims also exposed both orbits dorsally. Protection of the brain and exposed tissues and restoration of the cosmetic appearance of the skull were attempted by use of molded polymethylmethacrylate prosthetic reconstruction of the calvarium. The technique described involves cranioplasty by use of a preformed molded polymethylmethacrylate implant. Such prosthetic cranioplasty may benefit dogs undergoing radical excision of extensive tumors, and the usefulness and potential complications of its application are discussed.

Animals↗
PubMed1990

Bone flap replacement vs acrylic cranioplasty: a clinical audit.

A 5-year retrospective study comparing bone flap replacement with acrylic cranioplasty was carried out. There was no significant difference in the high infection rates associated with the two procedures. We suggest that antibiotic-impregnated acrylic cranioplasty may be the safest and best surgical procedure based on the orthopaedic experience with gentamicin-impregnated cement in joint replacement surgery.

Acrylic Resins↗
PubMed1992

Computer-generated titanium cranioplasty: report of a new technique for repairing skull defects.

A review of 40 cases of titanium cranioplasty fabricated from impressions taken of the defect through the patient's scalp in the conventional way showed that 23% were ill-fitting and 41% of frontal plates had a poor aesthetic result. Attributable factors were difficulty in defining the defect border accurately and limited information of the surrounding tissue architecture which led to strains produced during insertion. Inadequate communication between surgeon and prosthetist compounded these difficulties. A prospective study of six cases fabricated from CT computer-generated models of challenging cranial defects appears to show significant improvements in plate design, resulting in better plate adaptation, stability and aesthetic contour. Plate insertion was rapid (mean time 27 min) thereby minimizing operating time. This paper also discusses the advantages of the enhanced information derived from CT and describes the potential for pre-craniotomy template and matching cranioplasty, thereby permitting a one-stage procedure.

Computer Graphics↗
PubMed2004

Porous polyethylene implant for cranioplasty and skull base reconstruction.

OBJECT: Cranial reconstruction after skull base surgery is important for restoration of function and cosmesis. The authors describe their experience with the Medpor porous polyethylene implant for cosmetic cranioplasty and reconstruction after skull base surgery. METHODS: Medpor, a biocompatible implant, is flexible and can be contoured to facilitate surgical reconstruction of small to medium (< 8 cm) convexity or cranial base defects resulting from a variety of skull base approaches. This method provides similar cosmetic results to standard alloplast cranioplasty while decreasing operating time. The porous nature of the material allows ingrowth of soft tissue and bone to increase implant strength and decrease the risk of infection. This material can also be used safely in reconstruction of the cranium and skull base adjacent to the paranasal sinuses. CONCLUSIONS: The authors have used the Medpor porous polyethylene implant in 611 standard cranial and skull base procedures and have achieved excellent cosmetic results and no implant-related complications.

Absorbable Implants↗
PubMed1994

Cranioplasty with the Medpor porous polyethylene flexblock implant. Technical note.

The authors describe the use of a porous polyethylene Flexblock implant for cosmetic cranioplasty. The implant may be used to cover any small- or medium-sized (< 8 cm) cranial defect, offering similar cosmetic results to standard alloplast cranioplasty while decreasing operation time. The porous implant design permits ingrowth of soft tissue and bone to increase implant strength and decrease the risk of infection. The Flexblock alloplast has been utilized in 25 cases with excellent cosmetic results and no implant-related complications.

Biocompatible Materials↗
PubMed2001

Brain SPECT artifacts in patients having metallic cranioplasty.

OBJECTIVE: Over the past few years, we have performed several brain SPECT studies on patients who have had previous head trauma that required metallic cranioplasty. Transaxial images showed clearly defined photon-deficient areas extending from the brain tissue into the area of the scalp. To investigate the extent and pattern of this type of artifact, SPECT brain phantom studies were performed and compared with the patient studies. METHODS: SPECT brain phantom studies were performed using various metallic sheets to simulate metallic plates that were used for cranioplasty. RESULTS: Phantom studies using lead to represent tantalum plates were similar to our patient studies; that is, the photon-deficient area in normal brain tissue extended into the area where normal scalp activity would be. There was also increased tracer activity at the periphery of the photon-deficient area that extended to where normal scalp activity would be. This was similar to the patient studies and was not present on the phantom studies done without any metallic sheets present. CONCLUSION: One would expect photon-deficient artifacts caused by radiopaque metallic plates in brain SPECT studies. The patient and phantom studies demonstrate that an increased tracer activity artifact is also present at the periphery of the photon-deficient area that extends into the area of the scalp. Knowing the appearance of this type of artifact caused by radiopaque metallic plates in brain SPECT studies could be beneficial, especially in cases with poor patient history and lacking radiographic correlation.

Aged↗
PubMed1992

[The comparative characteristics of cranioplasty methods using biological materials].

Comparative results were obtained in the experiments conducted on dogs in cranioplasty using allogenic bones, one-piece or small-fragmentized brephoxenotransplants. It was found out that allogenic bones and brephoxenotransplants, when conserved in the solution of 0.2% of formaline and 0.1% of gl. aldehyde, were a perfect material for cranioplasty. These materials ensure a reparative osteogenesis in the recipient's organism after grafting. The process in small-fragmentized brephoxenotransplants is more active and ensures the bone recuperation of the vault of skull in 1.5 years.

Animals↗
PubMed2004

Methyl methacrylate cranioplasty.

We conducted a prospective study in order to audit our experience of repairing cranial defects using Methyl methacrylate. This included a total of 49 patients undergoing cranioplasty using methyl methacrylate, of which 45 were males and 4 females. The age of patients at the time of surgery ranged from 16 to 40 years old, with an average of 24 years. Malays were the majority (67%), followed by Chinese (23%) and Indian (10%). Cranial defects were mainly caused by motor vehicle accident (94%), while gunshot wounds, industrial accidents and tumours, each contribute 2%. Bone flaps were commonly removed during previous surgery related to traumatic subdural haemorrhage (33%), contusion (21%) and intracerebral haemorrhage (14%). The size of cranial defects ranged from 28 cm2 to 440 cm2, with an average of 201 cm2. Most had right sided (55%) and lateral defects [temporoparietal (52%) followed by temporal (16%), frontal (16%), frontotemporal (14%) and occipital (2%)]. Duration of surgery ranged from 70 to 275 minutes, with an average of 135 minutes. Nine of 12 patients (75%) with neurological disability had some improvement while 85% of symptomatic patients had symptoms improvement after cranioplasty. The infection rate in this series was 4%.

Adolescent↗
PubMed2005

[One-stage operation of ventriculo-peritoneal shunt and cranioplasty: analysis of 54 cases].

OBJECTIVE: To study the application of one-stage operation of ventriculo-peritoneal shunt and cranioplasty for hydrocephalus complicated by skull defect. METHOD: The clinical records of 54 patients with hydrocephalus complicated by skull defect treated with one-stage operation of ventriculo-peritoneal shunt and cranioplasty were reviewed in comparison with those of 30 patients receiving two-stage operations. RESULT: The clinical outcome of the patients receiving the two surgical procedures did not differ significantly, but two patients undergoing one-stage operation required replacement of the shunt pump due to elevation of intracranial pressure. Implementation of one-stage operations shortened the length of hospital stay and reduced the expense of patients. CONCLUSION: Hydrocephalus in combination with skull defect can be treated generally with one-stage operations and care must be taken in choosing adequate shunt tube according to the intracranial pressure measured preoperatively.

Adolescent↗
PubMed2005

[Clinical applications of devitalized autogenous calvarial bone flaps fixed with titanium clamps (CranioFix) for cranioplasty].

OBJECTIVE: To evaluate reimplantation of devitalized autogenous calvarial bone flaps and the fixation of titanium clamps (CranioFix) for cranioplasty. METHODS: From March 2000 to December 2003, 21 patients underwent (1) delayed reimplantation of preserved autogenous bone flaps, which were removed during the initial operations for increased intracranial pressure and stored in a freezer and autoclaved before use, or (2) immediate reimplantation of tumor invaded bone flaps that were devitalized by boiling. All of these flaps were fixed with titanium clamps (CranioFix). Resorption of the bone flaps was monitored by skull roentgenograms and computed tomography (CT). The clinical and aesthetic results were evaluated. RESULTS: During the follow-up period of 6 to 30 months, no complications were found. There was slight resorption of the bone flaps in all cases, but the edge of the bone flaps was within the range of the titanium clamps according to skull roentgenograms and CT. Clinical and aesthetic results were highly satisfactory. CONCLUSIONS: It is simple and practical using devitalized autogenous calvarial bone flaps for cranioplasty. The firmness decreasing of the reimplanted bone flap due to resorption can be prevented greatly by titanium clamps (CranioFix).

Adolescent↗
PubMed1986

Frontal cranioplasty: risk factors and choice of cranial vault reconstructive material.

A study of patients with large cranial defects involving the frontal bone, frontal sinus, nose, and orbit does not support the contention that there is a clear superiority of reconstructive material despite a history of previous bone infection. No patient with an isolated cranial reconstruction experienced an infection despite location in the area of the frontal sinus or the use of acrylic material. All patients experiencing infection underwent simultaneous reconstruction of the frontal cranium and nose and three- or four-wall reconstruction of the orbit, where the frontal sinus had previously been eliminated and where a previous bone infection had been present. Risk factors associated with cranioplasty were timing (p = 0.001) and cranial vault reconstruction in communication with previously infected ethmoid sinuses and the nose (p = 0.03). A history of previous bone infection suggests increased risk (p = 0.15). The choice of reconstructive material was not significant, although acrylic cranioplasties did not experience the complications expected from a review of the literature.

Adult↗
PubMed1977

[Cranioplasty; new ways (author's transl)].

Report on cranioplasty by prefabricated plastic implants, reinforced by stainless steel meshes resp. plates or by glass fibre meshes. In frontal cranioplasties the missing orbital roof was reconstructed by the same technique. To avoid infections the nasal sinuses were sealed by a pedicled mucosal flap resp. a free transplanted flap taken from the periosteum of the tibia. All 39 patients operated on this way during the last 6 years are free of complaints and clinical symptoms.

Acrylic Resins↗
PubMed1984

Composite autogeneic human cranioplasty: frozen skull supplemented with fresh iliac corticocancellous bone.

Skull totally exteriorized during craniotomy becomes nonviable. Resorption of the reimplanted cranial section occurs variably according to its treatment, the properties of the recipient bed, and the metabolic conditions of the host. Neurosurgeons commonly deep freeze autogeneic skull for preservation before delayed autogeneic cranioplasty. Aseptic necrosis commonly follows replacement of the autograft in its former cranial bed. This clinical study of six patients represents an attempt to block this destructive resorption by supplementing the frozen autograft with fresh corticocancellous autogeneic ilium. Observations of these patients ranging in age from 12 to 52 years support the following conclusions: (a) Osteogenesis was not enhanced by the addition of fresh corticocancellous bone to the frozen autoimplant. (b) The period of time that the autoimplant was frozen did not influence its subsequent biological behavior after cranioplasty. (c) Sterilization with ethylene oxide and in one case additional gamma irradiation did not impair the quality of the implant compared to those not sterilized. (d) Resorption occurred in both frozen and fresh but devitalized autogeneic skull. (e) Autogeneic skull is repaired by osteoconduction rather than by inducing competent perivascular stem cells to become osteogenic. (f) Freezing of autogeneic skull for preservation is practical, acceptable, but suboptimal from the perspectives of cerebral protection and cosmetic reconstruction. (g) The supplementation of the frozen autoimplant with fresh corticocancellous bone increases operating time and patient discomfort without affording additional benefit.

Adult↗