Clinical Outcome in Cranioplasty: Critical Review in Long-Term Follow-Up

Abstract

Various materials have been proposed for cranial reconstruction. Bone autograft and alloplasts such as polymethylmethacrylate (PMMA) and hydroxyapatite (HA) cement are most commonly used at the present time. Patients submitted for cranioplasty were evaluated. The prognostic factors influencing the results and the outcome were analyzed. Three hundred twelve patients who had 449 procedures performed by a single surgeon to reconstruct a calvarial deformity between 1981 and 2001 were studied. Post-tumor resection deformity was the main reason for cranioplasty (32.4%). Bone graft was the material of choice (69.5%). The main surgical site was the frontal bone (53.2%). Complications were observed in 23.6% of cases and were responsible for the least satisfactory results (P > 0.001), with infection and material exposure being the most critical complications. The eventual outcome was considered good in 91.8% of cases. The use of HA cement was associated with the worst results (P > 0.001). Bone grafts showed a high grade of partial resorption and required further surgery for correction. Multiple surgical procedures were correlated with a high rate of complications and an unsatisfactory outcome. Bone graft and PMMA are still the best materials in calvarial reconstruction. Even though HA cement is an osteoconductive material, it seems to induce what appears to be an immunoguided delayed inflammatory reaction that leads to thinning of the skin and exposure of the material, making secondary repair difficult. Before deciding which reconstructive option to use, a careful evaluation of the patient in terms of diagnosis, number of previous surgeries, and surgical site should be undertaken. If this is adopted, good results and a satisfactory outcome can be achieved on long-term follow-up.

Efficacy and Versatility of the 3-D Titanium Mesh Implant in the Closure of Large Post-Craniectomy Osseous Defects, and its Therapeutic Role in Reversing the Syndrome of the Trephined: Clinical Study of a Case Series and Review of Literature

“…Bone flap/graft resorption and infection [8,9], donor site morbidity, inadequate quantity of graft harvestable to bridge large cranial defects, prolonged intra-operative time, intraoperative blood loss and requirement of transfusions, need for surgical expertise and delayed post operative recovery [10] are definite drawbacks of autografting. Advanced age, presence of comorbidities, poor general condition of the patient, difficulties with bone flap storage, acute case scenarios and anatomical constraints can lead to difficulty in autografting or to the loss of the excised bone flap in a large number of cases [11,12]. At times, complications may result following Autogenous bone grafting, such as surgical site infection (SSI), graft/bone flap exposure, resorption, migration, hematomas and seromas [13].…”

What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients

“…[10] The material provides perfect biocompatibility, shape and fusion with the surrounding bone. [12] For preservation of an explanted flap until the delayed reimplantation, the material is either implanted into a subcutaneous pouch [2,13] or cryoconserved. [1,14] However, several major complications are related to reimplantation of autologous bone; e.g., epidural and subgaleal fluid collections and bleedings, infections, and resorption (aseptic necrosis) of the bone flap.…”

Cranioplasty of Hemispherical Defects Using Calcium Phosphate Cements Along with Titanium Mesh: Our Experience

“…Cranioplasty is often associated with a complication rate of 10-22.5 % [22][23][24][25]. Most of their complications were in cases involving frontal sinus and patients who had undergone irradiation.…”