Adult Cranioplasty Reconstruction With Customized Cranial Implants: Preferred Technique, Timing, and Biomaterials

Wolff, Amir; Santiago, Gabriel; Belzberg, Micah; Huggins, Charity; Lim, Michael; Weingart, Jon; Anderson, William S.; Coon, Alex; Huang, Judy; Brem, Henry; Gordon, Chad R.

doi:10.1097/scs.0000000000004385

Cited by 68 publications

(73 citation statements)

References 35 publications

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“…Such patients have an increased incidence of complications. 28 We believe that not a single factor, but a combination of factors finally resulted in massive brain swelling after cranioplasty in our patient.…”

Section: Intracranial Perfusion Pressure Changes: As Per Thementioning

confidence: 70%

Massive Brain Swelling after Cranioplasty: A Case Report

Zhang

Pan

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background Cranioplasty is a common procedure in neurosurgery. It is usually performed following decompressive craniectomy (DC). However, complications may occur after the operation, such as massive brain swelling. Up to now, far too little attention has been given to this severe complication. We report one case of fatal cerebral swelling after cranioplasty and analyze the possible mechanism of this complication. Case Description The patient was a 40-year-old man who had a severe right basal ganglia cerebral hemorrhage and underwent DC ∼ 2 months before. One day before scheduled cranioplasty, a lumbar cerebrospinal fluid drainage was placed. The cranioplasty itself was uneventful. However, he gradually fell into a coma, and his right pupil was moderately dilated 20 hours after the surgery. A brain computed tomography (CT) scan indicated massive right cerebral edema with compressed right midbrain. The patient did not regain consciousness, and he remained quadriplegic. Conclusion It is necessary to increase awareness of complications of cranioplasty in high-risk patients. The lessons learned from this case include avoiding excessive drainage of cerebrospinal fluid. Patients with low-density lesions in the brain need to be treated with caution. Once the CT scan shows massive cerebral swelling, the patient has a poor prognosis.

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Section: Intracranial Perfusion Pressure Changes: As Per Thementioning

confidence: 70%

Massive Brain Swelling after Cranioplasty: A Case Report

Zhang

Pan

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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“…Specifically, the implant was designed preoperatively based on 3-dimensional (3D)-CT (Figures 1 H- 1 K and 2 ) and fabricated with PMMA material. 16 Scalp dissection and cranial defect exposure was performed using our previously described pericranial-onlay technique. 16 , 17 …”

Section: Methodsmentioning

confidence: 99%

First-In-Human Experience With Integration of Wireless Intracranial Pressure Monitoring Device Within a Customized Cranial Implant

Mitchell

Anderson

Shay

et al. 2020

ONSURG

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BACKGROUND Decompressive craniectomy is a lifesaving treatment for intractable intracranial hypertension. For patients who survive, a second surgery for cranial reconstruction (cranioplasty) is required. The effect of cranioplasty on intracranial pressure (ICP) is unknown. OBJECTIVE To integrate the recently Food and Drug Administration-approved, fully implantable, noninvasive ICP sensor within a customized cranial implant (CCI) for postoperative monitoring in patients at high risk for intracranial hypertension. METHODS A 16-yr-old female presented for cranioplasty 4-mo after decompressive hemicraniectomy for craniocerebral gunshot wound. Given the persistent transcranial herniation with concomitant subdural hygroma, there was concern for intracranial hypertension following cranioplasty. Thus, cranial reconstruction was performed utilizing a CCI with an integrated wireless ICP sensor, and noninvasive postoperative monitoring was performed. RESULTS Intermittent ICP measurements were obtained twice daily using a wireless, handheld monitor. The ICP ranged from 2 to 10 mmHg in the supine position and from −5 to 4 mmHg in the sitting position. Interestingly, an average of 7 mmHg difference was consistently noted between the sitting and supine measurements. CONCLUSION This first-in-human experience demonstrates several notable findings, including (1) newfound safety and efficacy of integrating a wireless ICP sensor within a CCI for perioperative neuromonitoring; (2) proven restoration of normal ICP postcranioplasty despite severe preoperative transcranial herniation; and (3) proven restoration of postural ICP adaptations following cranioplasty. To the best of our knowledge, this is the first case demonstrating these intriguing findings with the potential to fundamentally alter the paradigm of cranial reconstruction.

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“…Большое количество научных работ посвящено сравнительному анализу результатов краниопластики с использованием аутологичных костных и синтетических трансплантатов. В ряде исследований показано использование синтетических индивидуальных протезов, которые имеют ряд преимуществ перед трансплантатами аутокости [36,37]. Gilardino et al проанализировали эффективность восстановления костей черепа с использованием аутопластики криоконсервированной костной тканью черепа, ребер и подвздошной кости в сравнении с пластикой полимерными синтетическими материалами, спроектированными с помощью компьютерных программ.…”

Section: сравнительная характеристика показателей ремоделирования траunclassified

Modern materials for the reconstruction of the cranial vault bones

Офицеров¹,

Borovkova²,

Talypov³

et al. 2019

Transplantologiâ (Mosk.)

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Introduction. The need for cranioplasty occurs after the removal of the bony structures of the cranial vault. Craniotomy can be performed both in emergency as in case of increased intracranial pressure, and as a planned operation in the treatment of neoplasms or abscesses. A long-lasting presence of an extensive bone defect is the cause of the "trephined skull" syndrome development. Currently, cranioplasty is performed with materials of synthetic or natural origin. Synthetic materials include hydroxyapatite, tricalcium phosphate, polymethyl methacrylate. The natural materials include the auto-, allo- and xenografts. The main disadvantage of bone autografts is their rapid lysis. The most promising solution to this problem may include a lyophilization method with transplant saturation with growth factors, the source of which can be autoplasma rich in platelets. Of particular relevance is the development of methods for the preparation and preservation of an autograft, its modification in order to increase osteoreparative properties, which will bring the cranioplasty method with natural transplants to a whole new level.The purpose of research. Combine relevant data and the results of a comprehensive analysis of the advantages and disadvantages of existing bone-plastic materials.

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Adult Cranioplasty Reconstruction With Customized Cranial Implants: Preferred Technique, Timing, and Biomaterials

Cited by 68 publications

References 35 publications

Massive Brain Swelling after Cranioplasty: A Case Report

Massive Brain Swelling after Cranioplasty: A Case Report

First-In-Human Experience With Integration of Wireless Intracranial Pressure Monitoring Device Within a Customized Cranial Implant

Modern materials for the reconstruction of the cranial vault bones

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