Complications and cosmetic outcomes of materials used in cranioplasty following decompressive craniectomy—a systematic review, pairwise meta-analysis, and network meta-analysis

Gerstl, Jakob V. E.; Rendón, Luis Fernando; Burke, Shane M.; Doucette, Joanne; Mekary, Rania A.; Smith, Timothy R.

doi:10.1007/s00701-022-05251-5

Cited by 9 publications

(12 citation statements)

References 73 publications

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“…At present, cranioplasty continues to be the predominant approach targeting calvarial defects. 11 – 14 Nonetheless, regardless of whether using autografts, allografts, or artificial scaffolds, the emphasis has consistently been the restoration of cranial hard tissues, neglecting the critical need for the reconstruction of suture mesenchyme. Regarding suture regeneration, investigations are conducted via the utilization of suture-containing bone flaps or MSC.…”

Section: Introductionmentioning

confidence: 99%

Transcriptomic and cellular decoding of scaffolds-induced suture mesenchyme regeneration

Wu,

Li,

et al. 2024

Int J Oral Sci

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Precise orchestration of cell fate determination underlies the success of scaffold-based skeletal regeneration. Despite extensive studies on mineralized parenchymal tissue rebuilding, regenerating and maintaining undifferentiated mesenchyme within calvarial bone remain very challenging with limited advances yet. Current knowledge has evidenced the indispensability of rebuilding suture mesenchymal stem cell niches to avoid severe brain or even systematic damage. But to date, the absence of promising therapeutic biomaterials/scaffolds remains. The reason lies in the shortage of fundamental knowledge and methodological evidence to understand the cellular fate regulations of scaffolds. To address these issues, in this study, we systematically investigated the cellular fate determinations and transcriptomic mechanisms by distinct types of commonly used calvarial scaffolds. Our data elucidated the natural processes without scaffold transplantation and demonstrated how different scaffolds altered in vivo cellular responses. A feasible scaffold, polylactic acid electrospinning membrane (PLA), was next identified to precisely control mesenchymal ingrowth and self-renewal to rebuild non-osteogenic suture-like tissue at the defect center, meanwhile supporting proper osteointegration with defect bony edges. Especially, transcriptome analysis and cellular mechanisms underlying the well-orchestrated cell fate determination of PLA were deciphered. This study for the first time cellularly decoded the fate regulations of scaffolds in suture-bony composite defect healing, offering clinicians potential choices for regenerating such complicated injuries.

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Section: Introductionmentioning

confidence: 99%

Transcriptomic and cellular decoding of scaffolds-induced suture mesenchyme regeneration

Wu,

Li,

et al. 2024

Int J Oral Sci

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“…Single materials differ in their strength, thermal properties, biocompatibility and radiographic features, while also related costs for health institutions vary sensibly [ 12 , 13 ]. Nevertheless, previous works comparing different implant materials with respect to surgical complications often came to contradictory conclusions, so that there is still no consensus on the best material for CP [ 14 , 15 ]. We have performed a retrospective analysis of CP after decompressive hemicraniectomy (DHC) including different materials in two hospitals.…”

Section: Introductionmentioning

confidence: 99%

Exploring complications following cranioplasty after decompressive hemicraniectomy: A retrospective bicenter assessment of autologous, PMMA and CAD implants

Pfnür,

Tosin,

Petkov

et al. 2024

Neurosurg Rev

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Cranioplasty (CP) after decompressive hemicraniectomy (DHC) is a common neurosurgical procedure with a high complication rate. The best material for the repair of large cranial defects is unclear. The aim of this study was to evaluate different implant materials regarding surgery related complications after CP. Type of materials include the autologous bone flap (ABF), polymethylmethacrylate (PMMA), calcium phosphate reinforced with titanium mesh (CaP-Ti), polyetheretherketone (PEEK) and hydroxyapatite (HA). A retrospective, descriptive, observational bicenter study was performed, medical data of all patients who underwent CP after DHC between January 1st, 2016 and December 31st, 2022 were analyzed. Follow-up was until December 31st, 2023. 139 consecutive patients with a median age of 54 years who received either PMMA (56/139; 40.3%), PEEK (35/139; 25.2%), CaP-Ti (21/139; 15.1%), ABF (25/139; 18.0%) or HA (2/139; 1.4%) cranial implant after DHC were included in the study. Median time from DHC to CP was 117 days and median follow-up period was 43 months. Surgical site infection was the most frequent surgery-related complication (13.7%; 19/139). PEEK implants were mostly affected (28.6%; 10/35), followed by ABF (20%; 5/25), CaP-Ti implants (9.5%; 2/21) and PMMA implants (1.7%, 1/56). Explantation was necessary for 9 PEEK implants (25.7%; 9/35), 6 ABFs (24.0%; 6/25), 3 CaP-Ti implants (14.3%; 3/21) and 4 PMMA implants (7.1%; 4/56). Besides infection, a postoperative hematoma was the most common cause. Median surgical time was 106 min, neither longer surgical time nor use of anticoagulation were significantly related to higher infection rates (p = 0.547; p = 0.152 respectively). Ventriculoperitoneal shunt implantation prior to CP was noted in 33.8% (47/139) and not significantly associated with surgical related complications. Perioperative lumbar drainage, due to bulging brain, inserted in 38 patients (27.3%; 38/139) before surgery was protective when it comes to explantation of the implant (p = 0.035). Based on our results, CP is still related to a relatively high number of infections and further complications. Implant material seems to have a high effect on postoperative infections, since surgical time, anticoagulation therapy and hydrocephalus did not show a statistically significant effect on postoperative complications in this study. PEEK implants and ABFs seem to possess higher risk of postoperative infection. More biocompatible implants such as CaP-Ti might be beneficial. Further, prospective studies are necessary to answer this question.

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“…Cranioplasty is defined as the reimplantation of either previously removed autologous skull flaps after a decompressive hemicraniectomy (DH) or implantation of a synthetic flap (SF) and is performed after regress of the malignant brain swelling at an interval of several weeks to months following DH [ 1 , 2 ]. Although the surgical procedure is regarded as one of the simplest in neurosurgery, it is associated with an unusually high rate of early and/or secondary postoperative complications [ 1 , 3 , 4 , 5 , 6 , 7 ]. Overall cranioplasty related complications are significantly higher after the reimplantation of an autologous bone flap (ABF) compared to an SF, mostly because of the development of bone flap resorption (BFR), which is only seen after cranioplasty with ABFs [ 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although the surgical procedure is regarded as one of the simplest in neurosurgery, it is associated with an unusually high rate of early and/or secondary postoperative complications [ 1 , 3 , 4 , 5 , 6 , 7 ]. Overall cranioplasty related complications are significantly higher after the reimplantation of an autologous bone flap (ABF) compared to an SF, mostly because of the development of bone flap resorption (BFR), which is only seen after cranioplasty with ABFs [ 6 , 8 ]. BFR, which is also called aseptic bone necrosis or osteonecrosis, has been long recognized as the most common ABF-specific cranioplasty complication with an estimated pooled incidence of 15% to almost every second patient, according to recently published clinical systematic reviews [ 3 , 4 , 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Overall cranioplasty related complications are significantly higher after the reimplantation of an autologous bone flap (ABF) compared to an SF, mostly because of the development of bone flap resorption (BFR), which is only seen after cranioplasty with ABFs [ 6 , 8 ]. BFR, which is also called aseptic bone necrosis or osteonecrosis, has been long recognized as the most common ABF-specific cranioplasty complication with an estimated pooled incidence of 15% to almost every second patient, according to recently published clinical systematic reviews [ 3 , 4 , 6 , 8 ]. Further specific volumetric studies on ABFs identified much higher rates of BFR, namely from 77 to 90% [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Explanted Skull Flaps after Decompressive Hemicraniectomy Demonstrate Relevant Bone Avitality-Is Their Reimplantation Worth the Risk?

Gousias,

Stricker,

Hoyer

et al. 2023

Brain Sciences

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Background: Reimplantations of autologous skull flaps after decompressive hemicraniectomies (DHs) are associated with high rates of postoperative bone flap resorption (BFR). We histologically assessed the cell viability of explanted bone flaps in certain periods of time after DH, in order to conclude whether precursors of BRF may be developed during their storage. Methods: Skull bone flaps explanted during a DH between 2019 and 2020 were stored in a freezer at either −23 °C or −80 °C. After their thawing process, the skulls were collected. Parameters of bone metabolism, namely PTH1 and OPG, were analyzed via immunohistochemistry. H&E stain was used to assess the degree of avital bone tissue, whereas the repeated assays were performed after 6 months. Results: A total of 17 stored skull flaps (8 at −23 °C; 9 at −80 °C) were analyzed. The duration of cryopreservation varied between 2 and 17 months. A relevant degree of bone avitality was observed in all skull flaps, which significantly increased at the repeated evaluation after 6 months (p < 0.001). Preservation at −23 °C (p = 0.006) as well as longer storage times (p < 0.001) were identified as prognostic factors for higher rates of bone avitality in a linear mixed regression model. Conclusions: Our novel finding shows a clear benefit from storage at −80° C, which should be carefully considered for the future management and storage of explanted skull flaps. Our analysis also further revealed a significant degree of bone avitality, a potential precursor of BFR, in skull flaps stored for several weeks. To this end, we should reconsider whether the reimplantation of autologous skull flaps instead of synthetic skull flaps is still justified.

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Complications and cosmetic outcomes of materials used in cranioplasty following decompressive craniectomy—a systematic review, pairwise meta-analysis, and network meta-analysis

Cited by 9 publications

References 73 publications

Transcriptomic and cellular decoding of scaffolds-induced suture mesenchyme regeneration

Transcriptomic and cellular decoding of scaffolds-induced suture mesenchyme regeneration

Exploring complications following cranioplasty after decompressive hemicraniectomy: A retrospective bicenter assessment of autologous, PMMA and CAD implants

Explanted Skull Flaps after Decompressive Hemicraniectomy Demonstrate Relevant Bone Avitality-Is Their Reimplantation Worth the Risk?

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