Long-term results following titanium cranioplasty of large skull defects

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Decompressive craniectomy is an established procedure to lower intracranial pressure. Therefore, cranioplasty remains a necessity in neurosurgery as well. If the patient's own bone flap is not available, the surgeon can choose between various alloplast grafts. A review of the literature proves that 4–13.8% of polymethylmethacrylate plates and 2.6–10% of hydroxyapatite-based implants require replacement. In this retrospective study of large skull defects, the authors compared computer-assisted design/computer-assisted modeled (CAD/CAM) titanium implants for cranioplasty with other frequently used materials described in literature.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Twenty-six patients underwent cranioplasty with CAD/CAM titanium implants (mean diameter 112 mm). With the aid of visual analog scales, the patients' pain and cosmesis were evaluated 6–12 years (mean 8.1 years) after insertion of the implants.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>None of the implants had to be removed. Of all patients, 68% declared their outcomes as excellent, 24% as good, 0.8% as fair, and 0% as poor. There was no resulting pain in 84% of the patients, and 88% were satisfied with the cosmetic result, noting &gt; 75 mm on the visual analog scale of cosmesis. All patients would have chosen cranioplasty again, stating an improvement in their quality of life by the calvarial reconstruction. Nevertheless, follow-up images obtained in 4 patients undergoing removal of meningiomas was only suboptimal.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>With the aid of CAD technology, all currently used alloplastic materials are suited even for large skull defect cranioplasty. Analysis of the authors' data and the literature shows that cranioplasty with CAD/CAM titanium implants provides the lowest rate of complications, reasonable costs, and acceptable postoperative imaging. Polymethylmethacrylate is suited for primary cranioplasty or for long-term follow-up imaging of tumors. Titanium implants seem to be the material of choice for secondary cranioplasty of large skull defects resulting from decompressive craniectomy after trauma or infarction. Expensive HA-based ceramics show no obvious advantage over titanium or PMMA.</jats:p></jats:sec>

Efficacy and Versatility of the 3-D Titanium Mesh Implant in the Closure of Large Post-Craniectomy Osseous Defects, and its Therapeutic Role in Reversing the Syndrome of the Trephined: Clinical Study of a Case Series and Review of Literature

“…Titanium mesh has been proved to have greater strength and provide a superior cranial contour restoration than the thin split thickness calvarial bone grafts [15]. Being a non-ferromagnetic metal, that is relatively radiolucent, Titanium induces no major artifacts, causes no significant scatter or image degradation on CT scans or on MRI and permits safe and accurate imaging of the brain in the long-term post operative follow up period [16].…”

Osteosarcoma of the cranial vault and skull base in pediatric patients

“…Titanium implants produce minimal metallic artifact on MRI and CT. 6,10,43 PEEK also produces minimal artifact on MRI, making it an excellent option for cranial reconstruction when autologous bone is unavailable or not suitable. 13 Radiation has largely been reserved for the management of unresectable disease and metastasis.…”

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

“…Key advantages of use lie in high immunological compatibility [36], as the implant is comprised of the patient's own tissue, as well as superior anatomical cosmesis, given it matches the injury profile directly [29]. Often, direct re-implantation of the autologous bone flap is not feasible and storage (either cryogenic or subcutaneous) is required to ensure the flap is preserved until re-implantation [21,68,69].…”