Complications of titanium cranioplasty—a retrospective analysis of 174 patients

Mukherjee, Soumya; Thakur, Bhaskar; Haq, Imran; Hettige, Samantha; Martin, Andrew

doi:10.1007/s00701-014-2024-x

Cited by 104 publications

(63 citation statements)

References 25 publications

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“…6) This data is comparable with several recent studies. 7,8) The exposed implant rate in titanium cranioplasty was recently reported as 13.9% (15 of 108 cases).…”

Section: Introductionsupporting

confidence: 92%

See 1 more Smart Citation

Exposure of Titanium Mesh after Cranioplasty for Microvascular Decompression Surgery: Two Case Reports

Watanabe

Amagasaki

Naemura

et al. 2015

NMC Case Report Journal

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but the complications of titanium cranioplasty for small skull defect caused by the lateral suboccipital approach, particularly microvascular decompression (MVD) surgery, have not been investigated.From April 2008 to November 2013, 417 titanium cranioplasties for small suboccipital craniectomy were performed in our institution. Four hundred and nine cases were treated with titanium cranioplasty after MVD primarily and eight cases were treated for repeated procedure after MVD. In this report, we present two cases of exposed titanium mesh. Both patients suffered from complications after repeated procedures. Case Reports I. Case 1A 62-year-old underweight female (height 157 cm, weight 45 kg, and BMI 18.3 kg/m 2 ), who had undergone MVD for left facial spasm and repair of cerebrospinal fluid leakage 5 years before at our hospital, visited again because she felt a strange projection under the left postauricular skin. The titanium mesh implanted at the second surgery was exposed from the operative scar (Fig. 1A). Computed tomography (CT) revealed exposure of the titanium mesh with no evidence of intracranial pathology (Fig. 1B, C), which indicated the need for removal of the titanium mesh. After obtaining informed consent, primary skin closure was completed after removal of the titanium mesh and debridement of the affected skin. No gross evidence of infection was observed. She was treated with intravenous cefazolin sodium hydrate (CEZ) 2 g/day for 5 days and discharged from our hospital with no evidence of further complication. II. Case 2A 75-year-old underweight female (height 150 cm, weight 38.6 kg, and BMI 17.2 kg/m 2 ), who had undergone MVD for right trigeminal neuralgia 10 years and 5 years before, visited our hospital again because she noticed mucus on the operative scar. The shape of titanium mesh that had been implanted at the second surgery was visible at the operative scar ( Fig. 2A). CT showed that the titanium mesh was exposed with partial absence of the skin. There was no evidence of subcutaneous or intracranial pathology (Fig. 2B, C). Removal of the titanium mesh was indicated and after obtaining informed consent, primary skin closure was completed using the same procedure as in the previous case. No definitive infection was observed around the affected wound Two cases of exposed titanium mesh occurred after implantation for cranioplasty after repeated procedures for microvascular decompression (MVD). Case 1 was a 62-year-old female who underwent MVD for left hemifacial spasm followed by repair of cerebrospinal fluid leak after the surgery, and Case 2 was a 75-year-old female who underwent MVD twice for right trigeminal neuralgia. Both patients visited our hospital again with complaints of postauricular lesion. Titanium mesh was visible through the operative scar and was successfully removed with no complication in both cases. Both patients were underweight females, and combined with multistep surgery may have contributed to the pathology. The present cases suggest that use of titanium mesh should be av...

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“…6) This data is comparable with several recent studies. 7,8) The exposed implant rate in titanium cranioplasty was recently reported as 13.9% (15 of 108 cases).…”

Section: Introductionsupporting

confidence: 92%

“…4,5) However, titanium implants may be associated with a significant rate of complications, most commonly infection, and re-operation was sometimes necessary. [6][7][8][9] Exposed implant is an important but less understood complication which can lead to both infection and cosmetic problems.…”

Section: Introductionmentioning

confidence: 99%

Exposure of Titanium Mesh after Cranioplasty for Microvascular Decompression Surgery: Two Case Reports

Watanabe

Amagasaki

Naemura

et al. 2015

NMC Case Report Journal

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show abstract

“…Titanium is often used in cranioplasty because it is believed to be bioinert and is rigid as well as compatible with magnetic resonance imaging. 3 Although titanium allergy is rare, the possibility of substantial morbidity is real. Death after an acute hypersensitivity reaction to a titanium cranioplasty mesh has been reported.…”

Section: Discussionmentioning

confidence: 99%

Modified Fixation of Acrylic Cranioplasty in the Setting of Titanium Allergy

Sinkin

Loftin²,

Baker³

2015

Journal of Craniofacial Surgery

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“…[44] One of the largest retrospective studies on titanium cranioplasties, conducted by Mukherjee et al in London, reported a failure and removal rate of 10.3% and infection rate of 8.6%. [45] When they evaluated reasons for failure, the presence of a previous infection and defect size greater than 100 cm 2 were associated with higher complication rates.…”

Section: Challenges In Cranial Defect Reconstructionmentioning

confidence: 99%

Bioinspired Collagen Scaffolds in Cranial Bone Regeneration: From Bedside to Bench

Lee

Volpicelli

2017

Adv Healthcare Materials

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Calvarial defects are common reconstructive dilemmas secondary to a variety of etiologies including traumatic brain injury, cerebrovascular disease, oncologic resection, and congenital anomalies. Reconstruction of the calvarium is generally undertaken for the purposes of cerebral protection, contour restoration for psychosocial well-being, and normalization of neurological dysfunction frequently found in patients with massive cranial defects. Current methods for reconstruction using autologous grafts, allogeneic grafts, or allo-plastic materials have significant drawbacks that are unique to each material. The combination of wide medical relevance and the need for a better clinical solution render defects of the cranial skeleton an ideal target for development of regenerative strategies focused on calvarial bone. With the improved understanding of the instructive properties of tissue-specific extracellular matrices and the advent of precise nanoscale modulation in materials science, strategies in regenerative medicine have shifted in paradigm. Previously considered to be simple carriers of stem cells and growth factors, increasing evidence exists for differential materials directing lineage specific differentiation of progenitor cells and tissue regeneration. In this work, we review the clinical challenges for calvarial reconstruction, the anatomy and physiology of bone, and extracellular matrix-inspired, collagen-based materials that have been tested for in vivo cranial defect healing.

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Complications of titanium cranioplasty—a retrospective analysis of 174 patients

Cited by 104 publications

References 25 publications

Exposure of Titanium Mesh after Cranioplasty for Microvascular Decompression Surgery: Two Case Reports

Exposure of Titanium Mesh after Cranioplasty for Microvascular Decompression Surgery: Two Case Reports

Modified Fixation of Acrylic Cranioplasty in the Setting of Titanium Allergy

Bioinspired Collagen Scaffolds in Cranial Bone Regeneration: From Bedside to Bench

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