Comparison of two different titanium cranioplasty methods: Custom-made titanium prostheses versus precurved titanium mesh

Abstract

Background: The aim of this study was to compare the results of two different titanium cranioplasties for reconstructing skull defects: standard precurved mesh versus custom-made prostheses. Methods: Retrospective analysis of 23 patients submitted to titanium cranioplasty between January 2014 and January 2019. Ten patients underwent delayed cranioplasty using custom-made prostheses; and 13 patients were treated using precurved titanium mesh (ten delayed cranioplasties, and three single-stage resection- reconstructions). Demographic, clinical, and radiological data were recorded. Results and complications of the two methods were compared, including duration of surgery, cosmetic results (visual analog scale for cosmesis [VASC]), and costs of the implants. Results: Complications: one epidural hematoma in the custom-made group, one delayed failure in precurved group due to wound dehiscence with mesh exposure. There were no infections in either group. All custom-made prostheses perfectly fitted on the defect; eight of 13 precurved mesh prostheses incompletely covered the defect. Custom-made cranioplasty obtained better cosmetic results (average VASC 94 vs. 68), shorter surgical time (141min vs. 186min), and -fewer screws was needed to fix the prostheses in place (6 vs. 15). However, satisfactory results were obtained using precurved mesh in cases of small defects and in single-stage reconstruction. Precurved mesh was found to be cheaper (€1,500 vs. €5,500). Conclusion: Custom-made cranioplasty obtained better results and we would suggest that this should be a first choice, particularly for young patients with a large cranial defect. Precurved mesh was cheaper and useful for single-stage resection-reconstruction. Depending on the individual conditions, both prostheses have their place in cranioplasty therapies.

Occipital cranioplasty using customized titanium prosthesis yields successful outcome in association with foramen magnum decompression in dogs suffering by Chiari-like malformation

“…The holes also allowed for the drainage of liquids, such as CSF or blood, from the surgical site, avoiding cerebellar compression. 29,30 Finally, the implant material is characterized by higher biocompatibility and osseointegration as well as bonelike elasticity and strength, and it is also associated with lower susceptibility to infection. [31][32][33] Although artifacts due to the metal nature of the implant made it difficult to evaluate the postoperative MRI images, the use of different sequences on different planes and the comparison of pre-and postoperative images allowed us to rule out a residual or new compression of the cerebellum in all cases.…”

Analysis of clinical efficiency and early postoperative complications after cranioplasty

“…Nevertheless, infectious complications may occur with incidence up to 16 %, especially, when treating large bone defects and patients after previous post-cranioplasty infection (48). When comparing the titanium implants only, the use of 3D printed custom-made implants resulted in more satisfactory results than the use of pre-curved titanium mesh implants, which are more useful in treatment of smaller cranial defects (48,49). Due to their mechanical stability and satisfactory cosmetic results, custom made titanium implants can also be used in the treatment of bone defects after craniofacial or maxillofacial skeleton resections (50,51) or compound injuries, which may be especially diffi cult to reconstruct (52,53).…”

Reconstruction of a Craniofacial Defect Using Rapid Prototyping and an Autograft - A Case Report

“…RPT specifically focuses on enhanced imagining tools providing the operator with the ability for precise preoperative planning, mirroring of the unaffected side, and designing a patient-specific prosthesis. [ 8 ] In our experience, RPT eliminates any discrepancy caused while making of impressions and models. [ 11 ] The prototype fabrication helps in the three-dimensional appearance and feel of the prosthesis, which was useful in surgical planning.…”

“…[ 7 ] Custom-designed prefabricated Ti prostheses have the unique advantages of precise fit, reduced surgical time, lower possibility of infection, faster recovery, and excellent cosmetics in craniofacial reconstruction. [ 7 8 ]…”