Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty — a questionnaire-based single-centre study

Fischer, C.; Burkhardt, Jan‐Karl; Sarnthein, Johannes; Bernays, René L.; Bozinov, Oliver

doi:10.1179/1743132812y.0000000007

Cited by 28 publications

(24 citation statements)

References 25 publications

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“…As shown in previous studies, cosmetic results matter to patients, especially in the frontotemporal region. 14 , 26 It has been shown that even a dent or irregularity of the cranioplasty may jeopardize the success of the surgery. 26 It was discovered that TCUS imaging may be painful within the first days after surgery, which is explained by the postoperative pain over the wound incision, and should be kept in mind when performed at bedside.…”

Section: Discussionmentioning

confidence: 99%

“… 14 , 26 It has been shown that even a dent or irregularity of the cranioplasty may jeopardize the success of the surgery. 26 It was discovered that TCUS imaging may be painful within the first days after surgery, which is explained by the postoperative pain over the wound incision, and should be kept in mind when performed at bedside. Our data showed that during outpatient follow-up there was no more pain after recovery from surgery and all patients enjoyed the opportunity to see the patent bypass together with the health care provider in real time.…”

Section: Discussionmentioning

confidence: 99%

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Safety, Feasibility, and Patient-Rated Outcome of Sonolucent Cranioplasty in Extracranial-Intracranial Bypass Surgery to Allow for Transcranioplasty Ultrasound Assessment

et al. 2020

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Objective We sought to analyze the safety and feasibility of elective sonolucent cranioplasty in the setting of extracranial-to-intracranial (EC-IC) bypass surgery to monitor bypass patency using ultrasound. Methods Patients who underwent direct EC-IC bypass surgery agreed to sonolucent cranioplasty at the time of surgery and received a sonolucent polymethyl methacrylate (PMMA) implant. Besides monitoring clinical outcome, all patients received transcranioplasty ultrasound (TCUS) on postoperative day 1 and at last follow-up. In addition, bypass patency was confirmed using catheter angiogram and fit of implant using computed tomography. Patient-rated outcome was assessed through phone questionnaire. Results EC-IC bypass surgery with PMMA cranioplasty was successful in all 7 patients with patent bypasses on postoperative angiogram. Direct TCUS was feasible in all patients, and bypass patency was monitored. There were no complications such as postoperative hemorrhagic/ischemic complications related to the bypass procedure in this patient population, as well as no complications related to the PMMA implant. Postoperative computed tomography showed favorable cosmetic results of the PMMA implant in both the pterional area for superficial temporal artery−middle cerebral artery bypasses and parietooccipital area for occipital artery−middle cerebral artery bypasses as confirmed by high-rated overall patient satisfaction with favorable cosmetic, pain, and sensory patient-rated outcomes. Conclusions In this study we were able to show that this novel technique is safe, allows for patency assessment of the EC-IC bypass using bedside TCUS technique, and is cosmetically satisfying for patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety, Feasibility, and Patient-Rated Outcome of Sonolucent Cranioplasty in Extracranial-Intracranial Bypass Surgery to Allow for Transcranioplasty Ultrasound Assessment

et al. 2020

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“…The major skull growth occurs in the first 2 years, achieving about 84% of the adult size, with a strong deceleration after that age. Even * As proposed by Fischer et al 8 † Implant size was assessed objectively from radiological images and postoperative treatment from patient records. The slice of greatest cross-sectional area of the defect was chosen for size analysis: small, medium, and large defects were defined as ≤ 50 cm 2 , 50-100 cm 2 , and ≥ 100 cm 2 , respectively.…”

Section: Discussionmentioning

confidence: 99%

“…All patients were strictly followed-up with serial clinical evaluations at 7, 14, 21, and 28 days, a CT scan at 6 months after the surgery, and clinical evaluation 12 months later. All families were administered a questionnaire (proposed by Fischer et al) 8 to assess how the patient (or parent in very young patients) judged the aesthetic result ( Table 2). The study was performed with approval from the Giannina Gaslini Institutional Review Board.…”

Section: Methodsmentioning

confidence: 99%

Surgical results of cranioplasty with a polymethylmethacrylate customized cranial implant in pediatric patients: a single-center experience

Fiaschi

Pavanello

Imperato

et al. 2016

PED

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OBJECTIVE Cranioplasty is a reconstructive procedure used to restore skull anatomy and repair skull defects. Optimal skull reconstruction is a challenge for neurosurgeons, and the strategy used to achieve the best result remains a topic of debate, especially in pediatric patients for whom the continuing skull growth makes the choice of material more difficult. When the native bone flap, which is universally accepted as the preferred option in pediatric patients, is unavailable, the authors' choice of prosthetic material is a polymethylmethacrylate (PMMA) implant designed using a custom-made technique. In this paper the authors present the results of their clinical series of 12 custom-made PMMA implants in pediatric patients. METHODS A retrospective study of the patients who had undergone cranioplasty at Gaslini Children's Hospital between 2006 and 2013 was conducted. A total of 12 consecutive cranioplasties in 12 patients was reviewed, in which a patient-specific PMMA implant was manufactured using a virtual 3D model and then transformed into a physical model using selective laser sintering or 3D printing. All patients or parents were administered a questionnaire to assess how the patient/parent judged the aesthetic result. RESULTS Patient age at craniectomy ranged from 5 months to 12.5 years, with a mean age of 84.33 months at cranioplasty. The mean extension of the custom-made plastic was 56.83 cm2. The mean time between craniectomy and cranioplasty was 9.25 months. The mean follow-up duration was 55.7 months. No major complications were recorded; 3 patients experienced minor/moderate complications (prosthesis dislocation, granuloma formation, and fluid collection). CONCLUSIONS In this patient series, PMMA resulted in an extremely low complication rate and the custom-made technique was associated with an excellent grade of patient or parent satisfaction on long-term follow up.

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“…Given this risk, an elective cranioplasty may offer a better cosmetic outcome for the patient. 8 Determination of this effect will of course require further evaluation with longer follow-up of a larger cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

Elective Sonolucent Cranioplasty for Real-Time Ultrasound Monitoring of Flow and Patency of an Extra- to Intracranial Bypass

Hadley

North

Srinivasan

et al. 2020

Journal of Craniofacial Surgery

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Cross-sectional imaging studies or catheter angiogram are the imaging modalities of choice to evaluate bypass patency after extra- to intracranial (EC-IC) bypass surgery. Although providing accurate results, these imaging modalities are time-consuming and/or present radiation risk for the patient. Ultrasound imaging is a fast and widely available imaging modality, but is limited in this setting due to the non-sonolucent autologous bone flap covering the bypass after surgery. The recently FDA approved clear polymethyl methacrylate (PMMA) cranioplasty implant overcomes this limitation by its sonolucent characteristic, but has not yet been used in the setting of EC-IC bypass surgery. Here, the authors describe for the first time the feasibility of an elective sonolucent cranioplasty to monitor flow and patency of an EC-IC bypass in real time using ultrasound. This moyamoya patient underwent a direct superficial temporal artery to middle cerebral artery (STA-MCA) bypass, after which a PMMA implant was used to close the craniotomy defect, instead of reimplanting the autologous bone flap. Immediate postoperative bedside transcranioplasty ultrasound confirmed bypass patency and allowed for quantitative flow measurements as well as for exclusion of postoperative hemorrhage. Postoperative CTA and catheter angiogram confirmed patency of the bypass without complications. This report shows for the first time that this technique is feasible and permits bedside transcranioplasty ultrasound assessment of bypass flow in real time, confirmed with angiography. This technique may permit easy comparison of baseline findings with follow up assessments and facilitate less invasive monitoring of bypass patency.

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Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty — a questionnaire-based single-centre study

Cited by 28 publications

References 25 publications

Safety, Feasibility, and Patient-Rated Outcome of Sonolucent Cranioplasty in Extracranial-Intracranial Bypass Surgery to Allow for Transcranioplasty Ultrasound Assessment

Safety, Feasibility, and Patient-Rated Outcome of Sonolucent Cranioplasty in Extracranial-Intracranial Bypass Surgery to Allow for Transcranioplasty Ultrasound Assessment

Surgical results of cranioplasty with a polymethylmethacrylate customized cranial implant in pediatric patients: a single-center experience

Elective Sonolucent Cranioplasty for Real-Time Ultrasound Monitoring of Flow and Patency of an Extra- to Intracranial Bypass

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