Cranioplasties for Congenital and Acquired Skull Defects in Children - Comparison of New Concepts with Conventional Methods

Abstract

From 1974 to 1992 fifty-two patients with congenital or acquired skull defects were operated at the Department of Pediatric Surgery of the University Children's Hospital of Zurich. By 1988, in 26 patients conventional methods with PMMA (polymethyl methacrylate) plasties or rib plasties were performed. After 1988, in 26 patients skull reconstruction was done by skull splitting, application of lyophilized bone or cartilage or a combination of both. In the latter period, stabilization and fixation was always provided by biodegradable screws and bands. The results of the different techniques were compared in a retrospective fashion. PMMA plasties provided immediately full stability and good cosmetic results. Another advantage was their availability. In one patient (= 4.8%), a wound infection required the removal of the plasty. In two other patients (9.5%), an increasing mobility of the plasty could be observed during skull growth. Rib plasties were not satisfying. Skull splitting or reconstruction with lyophilized bone or cartilage showed good results with a stable integration within 3-4 months. In one patient (4%), a superficial wound infection occurred, but it did not affect the plasty. From the present study, we conclude that skull splitting or the reconstruction of skull continuity by means of lyophilized bone or cartilage with fixation through biodegradable screws and bands are the methods of first choice in children, because they are fully integrated, avoid foreign material and might have a slightly lower risk of infection. In addition, removal of the implants may be avoided.(ABSTRACT TRUNCATED AT 250 WORDS)

Demineralized Bone Matrix and Resorbable Mesh Bilaminate Cranioplasty: A Novel Method for Reconstruction of Large-Scale Defects in the Pediatric Calvaria

“…Alternative autogenous sources of bone can be associated with considerable donor-site morbidity and, although alloplastic reconstructions have shown limited early efficacy, 2-5 they are nonetheless associated with complications, including infection, mobility, resorption, and fragmentation. 1,4,12,13,15 A recent study by Zins and colleagues further warned against using bone cement for large-scale calvarial defects. 1 Since the early observation of its successful osteoinduction in an athymic mouse model, demineralized bone has been shown to be osteoinductive in animal models and in human patients.…”

“…14 These forms of nonautogenous reconstruction carry the inherent risk of infection, extrusion, fragmentation, growth restriction, pathologic ossification, and inflammatory reactions. 1,4,12,13,15 These limitations have led to the search for an ideal method of skull reconstruction in these challenging cases. We present our experience with the demineralized bone matrix and resorbable mesh bilaminate cranioplasty, a novel method of reconstructing pediatric large-scale skull defects using demineralized bone matrix (DBX; Synthes, Inc., West Chester, Pa., and the Musculoskeletal Transplant Foundation, Edison, N.J.) sandwiched between two polylactic acid/polyglycolic acid resorbable mesh plates (Synthes).…”

“…Alternatives to autogenous material for reconstruction include bone cements, 1-6 demineralized bone, 7-10 porous polyethylene, hydroxyapatite, 11 methyl methacrylate, 12,13 and osteostimulative protein adjuvants. 14 These forms of nonautogenous reconstruction carry the inherent risk of infection, extrusion, fragmentation, growth restriction, pathologic ossification, and inflammatory reactions.…”

3-D titanium mesh reconstruction of defective skull after frontal craniectomy in traumatic brain injury

“…It appears that clinical improvements following cranioplasty may be due to the restoration of normal brain anatomy, cerebral reexpansion, and recovery of normal scalp flap curvature [5]. Various techniques and materials have been used in the repair of skull defects following DC, such as autogenous bone grafts and xenogenetic or alloplastic implants [1,[6][7][8][9][10]. Considerable advances have been made in computer-assisted design/manufacturing (CAD/ CAM) to improve the quality of implants.…”

Resorbier- und umbaubare Osteosynthesematerialien in der Mund-, Kiefer- und Gesichtschirurgie

“…men[153,154] wurden resorbierbare Schrauben und Bänder eingesetzt[9,10,[100][101][102]106]. Jüngste Ergebnisse in diesem Anwendungsbereich an 100 Säuglingen zeigten ausgezeichnete Resultate mit einem Kopolymer aus Milch-und Glykolsäure [57].…”