Adult Cranioplasty

Abstract

Objectives: After reading this article, the participant should be able to: Understand the etiology of cranial defects. Understand the anatomy of the cranium. Understand the importance of the preoperative workup in the cranial reconstruction decision-making process. Describe the options available for calvarial reconstruction including autologous and alloplastic materials. Describe the basic differences between available alloplastic materials. Understand the intraoperative and postoperative complications that may arise during cranioplasty. Summary: Cranial defects can arise from a variety of causes, yielding a diverse group of patients who require cranioplasty. The goals of calvarial reconstruction are to protect the underlying brain, to restore the aesthetic contour of the calvarium, and/or to treat postcraniectomy cerebrospinal fluid circulation abnormalities that may be symptomatic. Options for calvarial reconstruction include the autogenous bone flap that was removed for access, autologous bone grafting, and a variety of alloplastic materials such as titanium, hydroxyapatite, polymethylmethacrylate, polyether ether ketone, and high-density porous polyethylene. A detailed preoperative workup and discussion with the patient is important to choosing the appropriate reconstructive path.

Ultrasounds induce blood–brain barrier opening across a sonolucent polyolefin plate in an in vitro isolated brain preparation

“…An efficient sonolucent cranioplasty might change the perspective of US-mediated transient BBB disruption and, globally, of all TUS treatments requiring a wide sonication radius and repeated sonication sessions. Neuro-oncology provides a perfect example, as skull replacements are already largely employed 20 ; in this field, pharmacological therapies require multiple and closely planned sessions, the tight schedule of which would hinder the systematic application of current US-mediated BBB-disruption systems. The potential advantages of repeated BBB opening along chemotherapy have already been largely debated, and preliminary clinical experiences have already shown significant survival benefits in patients achieving BBB disruption, verified at post-insonation MRIs 17 .…”

“…As a matter of fact skull replacements are routinely used in neurosurgery for multiple purposes, encompassing the repair of congenital or acquired malformations, the reconstruction of large cranial defects, the resorption of skull bones as late complications of craniotomy procedures or oncological radicality; indeed, conditions associated with cranioplasty procedures include trauma, infection, stroke and brain tumors 20 . Of note, recent papers report advantages of using synthetic prostheses rather than autologous skull bone, such as lower rates of reoperation and local complications; however, most of the literature focuses on cranioplasty following decompressive craniectomy—regardless the cause—in which conservation processes are implied that do not subsist in elective procedures 21 , 22 .…”

The Antibiotic Immersion of Custom-Made Porous Hydroxyapatite Cranioplasty: A Multicentric Cohort Study

“…Newer materials used for alloplastic reconstruction of cranial defects, such as PMMA, PEEK, high-density porous polyethylene, and hydroxyapatite and (HA) can all be prefabricated to match a pre-existing cranial defect offering good contour restoration and shorter surgeries. 15…”

“…16,17 Newer materials used for alloplastic reconstruction of cranial defects, such as PMMA, PEEK, high-density porous polyethylene, and hydroxyapatite and (HA) can all be prefabricated to match a pre-existing cranial defect offering good contour restoration and shorter surgeries. 15 Polymethylmethacrylate is an acrylic resin that can be molded and offers strength and protection similar to that of native skull. 18 Because of its favorable safety profile and due to the fact that it is less expensive to manufacture than titanium mesh, prefabricated PMMA is the preferred implant material at some institutions.…”

A Robotic System for Implant Modification in Single-stage Cranioplasty

“…Cranioplasty is a procedure to treat cranial defects due to trauma, injury, or neurosurgical procedures for brain tumors, aneurysms or epilepsy [1]. Conventional cranioplasty is a two-stage process that repairs skull deformities in a delayed operation [2]. Such process requires the skull to be partially removed from the patient who then has to wait for the design and fabrication of the replacing implant for three to four weeks.…”