Cranioplasty using acrylic material: a new technical procedure

Chiarini, Luigi; Figurelli, Sabina; Pollastri, Giuseppe; Torcia, E; Ferrari, Francesca; Aglietta, Massimo; Nocini, Pier Francesco

doi:10.1016/j.jcms.2003.08.005

Cited by 108 publications

(94 citation statements)

References 14 publications

(11 reference statements)

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“…To achieve a satisfactory repair effect and reduce postoperative complications, good surgical skills and suitable repair materials are demanded. Various materials such as Plexiglas, bone cement, acrylic, and silicon rubber have been used to fill skull defects, 3,4,7 but have mostly been abandoned due to their poor biocompatibility, high incidence of infection, and formation of subcutaneous fluid effusions. Autogenous bone is also less frequently used because of its limited availability and different degrees of postimplantation absorption.…”

mentioning

confidence: 99%

Comparison of manually shaped and computer-shaped titanium mesh for repairing large frontotemporoparietal skull defects after traumatic brain injury

Luo

Liu²,

Xie³

et al. 2012

FOC

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Object The object of this study was to compare the effects and complications of manual and computer-aided shaping of titanium meshes for repairing large frontotemporoparietal skull defects following traumatic brain injury. Methods From March 2005 to June 2011, 161 patients with frontotemporoparietal skull defects were observed. Patients were divided into 2 groups according to the repair materials used for cranioplasty: 83 cases used computer-aided shaping for the titanium mesh, whereas the remaining 78 cases used a manually shaped titanium mesh. The advantages and disadvantages of the 2 methods were compared. Results No case of titanium mesh loosening occurred in either group. Subcutaneous fluid collection, titanium mesh tilt, and temporal muscle pain were the most common complications. In the manually shaped group, there were 14 cases of effusion, 10 cases of titanium mesh tilt, and 15 cases of temporal muscle pain. In the computer-aided group, there were 6 cases of effusion, 3 cases of titanium mesh tilt, and 6 cases of temporal muscle pain. The differences were significant between the 2 groups (p < 0.05). Other common complications were scalp infection, exposure of titanium mesh, epidural hematoma, and seizures. In the computer-aided group, the operative time decreased (p < 0.01), the number of screws used was reduced (p < 0.01), and the satisfaction of patients was significantly increased (p < 0.05). Conclusions Computer-aided shaping of titanium mesh for repairing large frontotemporoparietal skull defects decreases postoperative complications and the operative duration, reduces the number of screws used, increases the satisfaction of patients, and restores the appearance of the patient's head, making it an ideal choice for cranioplasty.

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mentioning

confidence: 99%

Comparison of manually shaped and computer-shaped titanium mesh for repairing large frontotemporoparietal skull defects after traumatic brain injury

Luo

Liu²,

Xie³

et al. 2012

FOC

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“…Despite the advantages, MMA has a high risk of extrusion, decomposition, and infection, and the residual monomer from cold polymerization may be toxic. 3,6,22 When MMA is ready to be used, it is mixed with a monomer that causes an exothermic reaction. While this makes the substance a malleable paste (Fig.…”

Section: Methyl Methacrylatementioning

confidence: 99%

Materials used in cranioplasty: a history and analysis

Shah

Jung

Skirboll

2014

FOC

316

305

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Cranioplasty, one of the oldest surgical procedures used to repair cranial defects, has undergone many revolutions over time to find the ideal material to improve patient prognosis. Cranioplasty offers cosmetic and protective benefits for patients with cranial defects. The first primitive cranioplasty procedures date back to 7000 bc and used metal and gourds to repair cranial defects. Cranioplasty was first documented by Fallopius who described repair using gold plates; the first bone graft was documented by van Meekeren. The first significant improvement for this procedure began with experimentation involving bone grafts in the late 19th century as a more natural approach for repairing cranial defects. The next impetus for advancement came because of wartime injuries incurred during World Wars I and II and involved experimentation with synthetic materials to counter the common complications associated with bone grafts. Methyl methacrylate, hydroxyapatite, ceramics, and polyetheretherketone implants among other materials have since been researched and used. Research now has shifted toward molecular biology to improve the ability of the patient to regenerate bone using bone growth factors. This paper reviews the evolution of materials used over time in addition to the various advantages and pitfalls associated with each change. It is important for neurosurgeons to be mindful of how these techniques have evolved in order to gain a better understanding of this procedure and how it has been adapted.

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“…It also exposes the patient to a potentially toxic monomer when cold polymerized and may cause exothermic thermal injury to the cerebrum when polymerized in situ. 11,14 Alloplastic alternatives to PMMA include hydroxyapatite, polyethylene, and bioactive glasses. Hydroxyapatite used in the cement form offers the advantages of malleability before hardening, osteoconductivity, and relative resistance to infection; however, it carries the disadvantages of being relatively expensive and does not fully convert to bone, so it is frequently used in conjunction with a structural support such as titanium mesh.…”

Section: Alloplastic Reconstructive Optionsmentioning

confidence: 99%

“…Heterotopic autograft, obtained from split-thickness local calvaria, rib, mandible, iliac crest, or tibia, eliminate the risk of immunologic reactivity or foreign body reaction. 11,14 However, donor site morbidity, increased surgical complexity, and graft site resorption render this option less desirable. 11,14,17 Calvarial allografts 18 and xenografts 14 eliminate the risk of donor site morbidity but offer suboptimal cosmesis and risk infection and immunologic reactivity that are unacceptable in light of the available alternatives.…”

Section: Biological Reconstructive Optionsmentioning

confidence: 99%

“…11,14 However, donor site morbidity, increased surgical complexity, and graft site resorption render this option less desirable. 11,14,17 Calvarial allografts 18 and xenografts 14 eliminate the risk of donor site morbidity but offer suboptimal cosmesis and risk infection and immunologic reactivity that are unacceptable in light of the available alternatives. Demineralized bone matrix represents a newer option for custom in situ cranioplasty that offers the advantages of osteoconductivity and minimized infectious and immunologic reactivity risks.…”

Section: Biological Reconstructive Optionsmentioning

confidence: 99%

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