Cranioplasty: Indications, procedures, and outcome – An institutional experience

Abstract

Background:Cranioplasty, the repair of a skull vault defect by insertion of an object (bone or nonbiological materials such as metal or plastic plates), is a well-known procedure in modern neurosurgery. Brain protection and cosmetic aspects are the major indications of cranioplasty. A retroprospective study was conducted for evaluating the indications, materials used, complications, and outcome of cranioplasty.Methods:This study was prospective from August 2013 to September 2015 and retrospective from August 2010 to July 2013. In the retrospective study, patients files were retrieved from the mentioned date (August 2010 to July 2013) from the medical records and the findings were recorded. Abstracted data included age at the time of cranioplasty (years), sex (male or female), medical comorbidities (hypertension, diabetes), indications for craniectomy [Road traffic accident (RTA), fall from height (FFH), hit by stone or cricket ball, physical assault, stroke, infection, shell injury, bullet injury, and intraoperative swelling], laterality of cranioplasty (bilateral, unilateral, or bifrontal), time between craniectomy and cranioplasty (weeks), type of graft (autologous or artificial), type of prosthesis if used (methylmethacrylate, titanium), storage of bone flap if used (subcutaneous or deep freezer), operative time (minutes), and complications fallowing cranioplasty.Results:Of the 236 patients included in the study, maximum were in the age group of 21–30 years i.e., 30.93% (n = 73). Mean age of the patients was 33.44 years. A total of 196 (83.05%) were autologous and 40 (16.95%) were artificial. Out of the 40 patients who underwent artificial cranioplasty, 36 (15.25%) had methylmethacrylate graft and 4 (1.7%) had titanium mesh implant. Bone was not preserved in 16.95% (n = 40), preserved in subcutaneous tissue in abdominal wall in 2.54% (n = 6), and preserved in deep freezer in 80.51% (n = 190) of the patients.Conclusion:Cranioplasty as a procedure is not without complications; however, if performed properly and at proper time with an aseptic technique, good results are achieved

Clinical, industrial, and research perspectives on powder bed fusion additively manufactured metal implants

“…Use of custom plates manufactured in this way has shown favourable outcomes in comparison to allografts, autografts, or alternative alloplasty materials including those shaped during surgery such as titanium mesh or polymethylmethacrylate [23,56]. Typically, a period of at least 3 months is kept between craniectomy and cranioplasty, though this waiting period may be up to 2 years where patients are not yet neurologically stable [23,57]. However, duration of pre-operative complications between the onset of a cranial defect and the cranial plate insertion is a significant complaint amongst patients [58], and there remains conflicting evidence of whether shortening the period between craniotomy and plate cranioplasty negatively affects patient outcome; systematic review of literature by Tasiou et al found that later cranioplasty may minimise surgical complications, but early cranioplasty indicated improvement in key postoperative indicators and reduced overall hospital stay duration [59][60][61][62][63].…”

Complications of cranioplasty in relationship to traumatic brain injury: a systematic review and meta-analysis

“…Despite being a time-honored and seemingly "straightforward" procedure, CP is burdened by a complication rate of up to 40%, some of which are severe enough to compromise the outcome of the initial brain injury [3][4][5]. Documented complications following CP include, among others: seizures, ICH, EFC, infections, hydrocephalus, BFR, mechanical complications (MC), cerebral edema, and neurological deficits (NDs) [3,[6][7][8][9].…”

Use of an Acellular Dermal Matrix Graft to Address a Contour Deformity in the Temporal Fossa: A Novel Application

“…While computer-aided implant designs provide a precise fit for cranial deficits, they do not address the issue of soft tissue coverage or muscular atrophy, the frequent factors associated with traumatic head injury repair [3]. Obtaining desirable cosmetic outcomes following cranioplasty of the frontotemporoparietal region of the cranium is particularly challenging.…”