Cranioplasty Using a Mixture of Biologic and Nonbiologic Agents

Abstract

IMPORTANCE A surgeon faces challenges with cranioplasty techniques to achieve a successful result with relatively few complications.OBJECTIVE To describe a unique technique for incorporating both biologic autologous bone and nonbiologic allograft materials for defect coverage in cranioplasty with favorable outcomes and low occurrence of complications. DESIGN, SETTING, AND PARTICIPANTSA retrospective medical records review of all 26 patients who underwent primary cranioplasty procedure with a modified technique between January 2011 and December 2015 at a high-volume head and neck oncologic reconstructive practice was conducted; data analysis was also performed during that period. After several years of experience with traditional cranioplasty maneuvers, the modified technique has evolved to incorporate both autologous bone grafts and alloplastic materials in the formation of a shapeable on-lay material. Data were collected on demographics, need for cranioplasty, materials used, outcomes, and risk factors. MAIN OUTCOMES AND MEASURESRates of infection, hematoma, flap loss or resorption, cerebrospinal fluid leak, hardware exposure or malfunction, and repeated reconstruction. RESULTSOf the 26 patients, 21 (81%) were men; mean (SD) age was 65.8 (14.3) years. Eight (31%) patients had a history of diabetes, 4 (15%) patients were receiving immunosuppressive drugs, and 5 (19%) patients were active smokers at the time of surgery. Neoplasia was the most common cause of the calvarial defect seen, responsible for 20 of 28 (71%) operative defects and necessitated procedures. All but 1 patient achieved successful mineralization following primary cranioplasty with the modified technique; this success was verified based on physical examination and follow-up imaging. Complications were rare and involved only 3 patients who developed postoperative infection; 1 (4%) of these patients lost the integrity of the cranioplasty. Thus, the rate of infection was 11% and loss rate was 4%. Preoperative and postoperative radiotherapy appeared to have no bearing on graft survival. CONCLUSIONS AND RELEVANCEThe results using a unique technique for incorporating both biologic autologous bone and nonbiologic allograft materials for defect coverage in cranioplasty are favorable, with satisfactory aesthetic outcomes and limited postoperative complications.LEVEL OF EVIDENCE 4.

Comparative Cost-Effectiveness of Cranioplasty Implants

“…The potential for revascularization and consolidation of autogenous split skull bone grafts results in the preference of this material for cranioplasty, particularly in reconstruction of frontal skull defects adjacent to paranasal sinuses. 1,[9][10][11][12] Nonetheless, pitfalls of autogenous implants include long operative durations, donor site morbidity, and a high risk of reabsorption resulting in visible surface contour irregularities. 9,10,13,14 Advances in biocompatible materials and custom computergenerated implants (CCGIs) 1,15 have broadened the reconstructive options available to surgeons.…”

Conditioning of 3D Printed Nanoengineered Ionic–Covalent Entanglement Scaffolds with iP‐hMSCs Derived Matrix

“…Some of the complex CMF cases require repair by cranioplasty to protect intracranial contents, re-establish anatomical boundaries between intra and extra-cranial structures, restore aesthetic craniofacial contour, and support craniofacial soft tissues [2] . Although the material choice and practices regarding cranioplasty can be largely dependent on the nature of the defect and surgeon preferences [3,4] , autologous bone grafts are considered the gold standard reconstructive material for CMF repair [5,6] . However, this technique relies on a limited source of donor tissue, incurs donor-site morbidity, and the complex geometries of bone within the CMF region cannot be easily recapitulated [2,3] .…”

Progressive Scalp Thinning Over Mesh Cranioplasty and the Role of Lipotransfer

“…The skull establishes an anatomic boundary between intracranial and extracranial contents and provides robust protection to central nervous system components . Cranial defects can be the result of congenital deformities, traumatic injuries, infection, and surgical or oncological ablative procedures .…”

“…Cranioplasty success relies in part on defect size, location, and patient comorbidities, but it also relies on the reconstructive method . The optimal material for cranioplasty is the one that is inexpensive and readily available, biocompatible, non‐thermoconducive, radio‐lucent, and light and malleable yet strong enough to withstand pressure overtime . Unfortunately, no single material perfectly fits these criteria to be a surgically and aesthetically desirable implant.…”

“…Unfortunately, no single material perfectly fits these criteria to be a surgically and aesthetically desirable implant. The gold‐standard material for cranioplasty has been autologous bone, however, this adds donor site morbidity and is susceptible to bone resorption over time . Furthermore, recreation of the natural contour of the skull can be difficult with autologous sources, and there may be insufficient volume of autologous bone for reconstruction of larger defects.…”