Complications After In Vivo and Ex Vivo Autologous Bone Flap Storage for Cranioplasty: A Comparative Analysis of the Literature

Corliss, Brian M.; Gooldy, Timothy C.; Vaziri, Sasha; Kubilis, Paul; Murad, Gregory J. A.; Fargen, Kyle M

doi:10.1016/j.wneu.2016.09.025

Cited by 61 publications

(31 citation statements)

References 40 publications

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“…Autologous bone grafts have been the standard for reconstructive treatment. However, the relatively high resorption, protrusion, and infection rates and the high rate of donor-site morbidities still represent major obstacles ( 1 – 3 ). Several alloplastic materials have been introduced as alternatives, including polymethyl methacrylate, polyether ether ketone (PEEK), polyethylene, titanium, and injectable/moldable calcium phosphate-based bone cement.…”

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confidence: 99%

In situ bone regeneration of large cranial defects using synthetic ceramic implants with a tailored composition and design

Omar

Engstrand

Linder

et al. 2020

Proc. Natl. Acad. Sci. U.S.A.

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The repair of large cranial defects with bone is a major clinical challenge that necessitates novel materials and engineering solutions. Three-dimensionally (3D) printed bioceramic (BioCer) implants consisting of additively manufactured titanium frames enveloped with CaP BioCer or titanium control implants with similar designs were implanted in the ovine skull and at s.c. sites and retrieved after 12 and 3 mo, respectively. Samples were collected for morphological, ultrastructural, and compositional analyses using histology, electron microscopy, and Raman spectroscopy. Here, we show that BioCer implants provide osteoinductive and microarchitectural cues that promote in situ bone regeneration at locations distant from existing host bone, whereas bone regeneration with inert titanium implants was confined to ingrowth from the defect boundaries. The BioCer implant promoted bone regeneration at nonosseous sites, and bone bonding to the implant was demonstrated at the ultrastructural level. BioCer transformed to carbonated apatite in vivo, and the regenerated bone displayed a molecular composition indistinguishable from that of native bone. Proof-of-principle that this approach may represent a shift from mere reconstruction to in situ regeneration was provided by a retrieved human specimen, showing that the BioCer was transformed into well-vascularized osteonal bone, with a morphology, ultrastructure, and composition similar to those of native human skull bone.

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mentioning

confidence: 99%

In situ bone regeneration of large cranial defects using synthetic ceramic implants with a tailored composition and design

Omar

Engstrand

Linder

et al. 2020

Proc. Natl. Acad. Sci. U.S.A.

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“…The poor systemic condition of patient and associated co-morbidities warrant subcutaneous preservation of autologous bone, at times. Clinical review by Brian et al, 11 has found no statistically signifi cant differences in clinical outcomes(infection, resorption, reoperation) when comparing storage methods for these two bone fl ap preservation. This study suggests that both strategies may be used safely and successfully.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcome of Exvivo Preserved Autologous Cranioplasty - A Novel Approach

Shakya

Thapa

2019

Nep J Neurosci

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Autologous cranioplasty is an increasingly common procedure performed in neurosurgical centers following a decompressive craniectomy. Available evidence on the safety of autologous bone flap preservation and cranioplasty is limited due to a large diversity in study conducted, nature of pathology and reported outcomes. In this Institutional Review Board-approved retrospective observational study, patients who underwent neurosurgical intervention as“craniectomy followed by cranioplasty” at the Department of Neurological Surgery, Kathmandu Medical College Teaching Hospital were enrolled retrospectively from 1st May 2012 to 30th April2019. The craniectomy bone flap was preserved exvivo, dipped in spirit solution in deep freeze, then autoclaved prior to cranioplasty. Data were collected from the hospital’s electronic database. Information analyzed included patient age, sex, indication forcraniectomy, interval between craniectomy and cranioplasty, length of hospital stay, peri-operativecomplications and mean time of follow-up. Patients who underwent a cranioplasty following removal of an infected bone flap after a craniotomy were excluded from the study. Associated complications were assessed and statistical analysis was performed using a Fisher’s exact test. There were a total of 210 patients with 92vascular, 58 post traumatic. With all these surgeries undergone we had 9% complication rate, all of whom underwent cranioplasty later than four weeks of primary surgery (p = <0.0001).Ex-vivo preservation and autoclaving of bone flap is a simple technique with significant benefits in our hospital and national scenario with significantly less financial burden to patients

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“…Although high resorption rates could be shown after autoclaving, there appear to be no statistically significant differences between cryopreservation and abdominal subcutaneous preservation with respect to bone resorption. 25,26 There exists no systematic evaluation of subcutaneous bone preservation in children, so it is not possible to estimate the risk of bone resorption with this method. 20 Although this study has certain limitations such as its single-center character, retrospective design, and limited number of patients, we could demonstrate differences between a pediatric and an adult population.…”

Section: Discussionmentioning

confidence: 99%

A Comparison between Pediatric and Adult Patients after Cranioplasty: Aseptic Bone Resorption Causes Earlier Revision in Children

Göttsche

Fritzsche

Kammler

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims/Objective Cranioplasty, a common neurosurgical intervention following decompressive craniectomy (DC), is associated with high complication rates. Bone flap resorption in particular leads to a considerable number of patients requiring further surgery. The aim of this study was to investigate the frequency and time of occurrence of complications following cranioplastic procedures in children and adults. Material and Methods Data of children and adults who underwent cranioplasty between July 2010 and March 2018 were analyzed retrospectively. Clinical data, complications, and risk factors regarding aseptic bone resorption (ABR) were evaluated including patient age, occurrence of shunt-dependent hydrocephalus, and number of fragments in autologous bone flaps. Results Severe traumatic brain injury (TBI) was the leading cause for DC among children (66.7%), associated with a significantly higher number of fragments (p = 0.002). In the adult population, the most common cause was malignant infarction (55.9%) followed by TBI (24.6%). Pediatric patients in our institution received autologous bone flaps less frequently than adult patients (61.1% and 83.1%, respectively). Young age and a higher number of fragments in autologous bone flaps were associated with the occurrence of ABR. Children and adolescents showed significantly higher rates of aseptic bone necrosis (p = 0.007) and revision cranioplasty (p = 0.036). Kaplan-Meier estimates were used to further analyze bone flap resorption in children and adults, showing that revision surgery due to ABR was performed earlier in children (p = 0.001, log-rank test). Conclusion Pediatric patients demand specific care when cranioplasty is performed following DC. We identified age as an independent risk factor. The higher number of fragments appears to be a correlation due to the higher number of TBIs in children. Our data indicate that young age is the most important risk factor for the development of ABR as a frequent and early complication with a shorter revision-free time interval in children. Consequently, the uncritical use of cryopreserved autologous bone flaps should be questioned in this population.

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Complications After In Vivo and Ex Vivo Autologous Bone Flap Storage for Cranioplasty: A Comparative Analysis of the Literature

Cited by 61 publications

References 40 publications

In situ bone regeneration of large cranial defects using synthetic ceramic implants with a tailored composition and design

In situ bone regeneration of large cranial defects using synthetic ceramic implants with a tailored composition and design

Surgical Outcome of Exvivo Preserved Autologous Cranioplasty - A Novel Approach

A Comparison between Pediatric and Adult Patients after Cranioplasty: Aseptic Bone Resorption Causes Earlier Revision in Children

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