Cranioplasty for Large Skull Defects with PMMA (Polymethylmethacrylate) or Tutoplast® Processed Autogenic Bone Grafts

Kriegel, R.; Schaller, Christiane; Clusmann, Hans

doi:10.1055/s-2007-985857

Cited by 55 publications

(28 citation statements)

References 26 publications

(40 reference statements)

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“…21 The postcranioplasty infection rate among 151 PEEK implants in our series was 6%, and, as in other studies, suggests that synthetic prostheses have infection rates similar to those with ABFs. 4,14,19,23,25,[27][28][29] Most important in our results is the favorable comparison between protocols A and B as regards the reimplantation of +ABFs despite intraoperative bone cultures of skin flora. Specifically, there was no increased risk of postcranioplasty infection in cases in which a +ABF was reimplanted, and there was no concordance between the organisms from the few postcranioplasty infections using +ABF and the original intraoperative cultured organisms at the time of craniectomy.…”

Section: Discussionmentioning

confidence: 68%

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Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Morton¹,

Abecassis²,

Hanson³

et al. 2016

JNS

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Predictors of infection afterobJective The authors' aim was to report the largest study on predictors of infection after cranioplasty and to assess the predictive value of intraoperative bone flap cultures before cryopreservation. methods They retrospectively examined all cranioplasties performed between March 2004 and November 2014. Throughout this study period, the standard protocol during initial craniectomy was to obtain a culture swab of the extracted autologous bone flap (ABF)-prior to its placement in cytostorage-to screen for microbial contamination. Two consecutive protocols were employed for the use and interpretation of the intraoperative swab culture results: A) From March 2004 through June 2013, any culture-positive ABF (+ABF) was discarded and a custom synthetic prosthesis was implanted at the time of cranioplasty. B) From July 2013 through November 2014, any ABF with a skin flora organism was not discarded. Instead, cryopreservation was maintained and the +ABF was re-implanted after a 10-minute soak in bacitracin irrigation as well as a 3-minute soak in betadine. results Over the 10.75-year period, 754 cranioplasty procedures were performed. The median time from craniectomy to cranioplasty was 123 days. Median follow-up after cranioplasty was 237 days for protocol A and 225 days for protocol B. The overall infection rate after cranioplasty was 6.6% (50 cases) occurring at a median postoperative Day 31. Staphylococcus spp. were involved as the causative organisms in 60% of cases. Culture swabs taken at the time of initial craniectomy were available for 640 ABFs as 114 ABFs were not salvageable. One hundred twenty-six (20%) were culture positive. Eighty-nine +ABFs occurred during protocol A and were discarded in favor of a synthetic prosthesis at the time of cranioplasty, whereas 37 +ABFs occurred under protocol B and were reimplanted at the time of cranioplasty. Cranioplasty material did not affect the postcranioplasty infection rate. There was no significant difference in the infection rate among sterile ABFs (7%), +ABFs (8%), and synthetic prostheses (5.5%; p = 0.425). All 3 +ABF infections under protocol B were caused by organisms that differed from those in the original intraoperative bone culture from the initial craniectomy. A cranioplasty procedure ≤ 14 days after initial craniectomy was the only significant predictor of postcranioplasty infection (p = 0.007, HR 3.62). coNclusioNs Cranioplasty procedures should be performed at least 14 days after initial craniectomy to minimize infection risk. Obtaining intraoperative bone cultures at the time of craniectomy in the absence of clinical infection should be discontinued as the culture results were not a useful predictor of postcranioplasty infection and led to the unnecessary use of synthetic prostheses and increased health care costs.

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Section: Discussionmentioning

confidence: 68%

“…This relatively common neurosurgical procedure is associated with complication rates of 15%-35%, 4,6,[8][9][10][12][13][14][15][16][17][18][19][20][22][23][24][25][26][27][28][29] with the most frequent complication being postoperative infection. The highest reported clinical infection rate after cranioplasty is 26%.…”

mentioning

confidence: 99%

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Morton¹,

Abecassis²,

Hanson³

et al. 2016

JNS

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“…Acquired skull deformities often occur as a result of trauma or infection or may be caused by previous neurosurgical procedures using craniotomy (1)(2)(3). A variety of autogenous and alloplastic materials are available to surgically cover these skull defects.…”

Section: Introductionmentioning

confidence: 99%

Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty — a questionnaire-based single-centre study

Fischer

Burkhardt

Sarnthein

et al. 2012

Neurological Research

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OBJECTIVES: Acquired skull deformities are common and most likely treated surgically by cranioplasty. Since data on patient aesthetic outcome after cranioplasty are rare in literature, we aimed to assess patient satisfaction after polymethyl-methacrylate (PMMA) cranioplasty in this study using a questionnaire. METHODS: A patient questionnaire was developed to evaluate the grade of satisfaction after surgery. After approval by the institutional ethical review board, we were allowed to send to all 115 patients, who received a cranioplasty from 2001 to 2008 at the University Hospital of Zurich, our questionnaire once to retrospectively analyze the patient response together with the patient hospital records. RESULTS: Out of 115 patients, 36 patients were lost to follow-up and our questionnaire was sent out once to 79 patients. Sixty-three of 79 patients replied to the questionnaire (79·7%) and 16 did not reply. Seventeen declined to participate in this study and out of the remaining 46 patients (58·2%, 18 women, mean age 54 years, range 20-83 years), who agreed to participate in this study, 22 (47·8%) judged their cranioplasty to be aesthetically 'excellent', 16 (34·8%) 'favorable' and 4 (8·7%) 'poor'. Another four patients (8·7%) were not satisfied, asking for a surgical revision. Patient age and gender was not related to the assessment of the aesthetic result. A higher satisfaction grade was found in patients with primary PMMA cranioplasty compared to PMMA cranioplasty implanted during a second surgery (Fisher's exact test, P = 0·031). A dent was strongly associated with absence of satisfaction (P<0·01, Fisher's exact test). CONCLUSION: Our questionnaire was suitable to assess patient satisfaction after cranioplasty. Localization of cranioplasty showed to be an important factor of aesthetic outcome, especially in the fronto-temporal region where a carefully planned reconstruction should be performed to guarantee an excellent grade of satisfaction after surgery. AbstractObjectives Acquired skull deformities are common and most likely treated surgically by cranioplasty. Since data on patient aesthetic outcome after cranioplasty are rare in literature, we aimed to assess patient satisfaction after polymethyl-methacrylate (PMMA) cranioplasty in this study using a questionnaire.Methods A patient questionnaire was developed to evaluate the grade of satisfaction after Results Out of 115 patients, 36 patients were lost to follow-up and our questionnaire was sent out once to 79 patients. 63 of 79 patients replied to the questionnaire (79.7%) and 16 did not reply. 17 declined to participate in this study and out of the remaining 46 patients (58.2%, 18women, mean age 54y, range 20-83y), who agreed to participate in this study, 22 (47.8%) judged their cranioplasty to be aesthetically "excellent", 16 (34.8%) "favorable" and 4 (8.7%) "poor". Another 4 patients (8.7%) were not satisfied, asking for a surgical revision. Patient age and gender was not related to the assessment of the aesthetic result. A higher satisfact...

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“…27,66 Once patients undergo decompressive craniectomy, those who survive are obligated to undergo a second procedure for surgical cranial reconstruction, that is, cranioplasty. Much of the modern literature regarding cranioplasty following decompressive craniectomy is based on case series that emphasize the technical aspects of the procedure such as the use of materials, 2,3,9,10,12,14,26,30,33,35,[50][51][52]54,55,60,63,68,70,71 the use of techniques to store the bone flap prior to reconstruction, 16,19,24,25,43,48,49,72 the timing of surgical intervention, 6,37 or other specific modifications to either the craniectomy or cranioplasty procedure, which may influence the cranioplasty. 20,28,34,36,38,41,47,67 There are relatively few modern-day large clinical series describing the clinical outcomes and perioperative complications of cranioplasties in the setting of nonpenetrating traumatic brain injury and large vessel infarction.…”

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confidence: 99%

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

Gooch

Gin²,

Kenning³

et al. 2009

FOC

388

261

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Object Decompressive craniectomy is a potentially life-saving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or cerebral infarction. Once performed, surviving patients are obligated to undergo a second procedure for cranial reconstruction. The complications following cranial reconstruction are not well described in the literature and may very well be underreported. A review of the complications would suggest measures to improve the care of these patients. Methods A retrospective chart review was undertaken of all patients who had undergone cranioplasty during a 7-year period. Demographic data, indications for craniectomy, as well as preoperative, intraoperative, and postoperative parameters following cranioplasty, were recorded. Perioperative and postoperative complications were also recorded. Patients were classified as having no complications, any complications, and complications requiring reoperation. The groups were compared to identify risk factors predictive of poor outcomes. Results The authors identified 62 patients who had undergone cranioplasty. The immediate postoperative complication rate was 34%. Of these, 46 patients did not require reoperation and 16 did. Of those requiring reoperation, 7 were due to infection, 2 from wound breakdown, 2 from intracranial hemorrhage, 3 from bone resorption, and 1 from a sunken cranioplasty, and 1 patient's cranioplasty procedure was prematurely ended due to intraoperative hypotension and bradycardia. The only factor statistically associated with need for reoperation was the presence of a bifrontal cranial defect (bifrontal: 8 [67%] of 12, requiring reoperation; unilateral: 8 [16%] of 49 requiring reoperation; p < 0.01) Conclusions Cranioplasty following decompressive craniectomy is associated with a high complication rate. Patients undergoing a bifrontal craniectomy are at significantly increased risk for postcranioplasty complications, including the need for reoperation.

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Cranioplasty for Large Skull Defects with PMMA (Polymethylmethacrylate) or Tutoplast® Processed Autogenic Bone Grafts

Cited by 55 publications

References 26 publications

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty — a questionnaire-based single-centre study

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

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