New Reconstructive Technologies after Decompressive Craniectomy in Traumatic Brain Injury: The Role of Three-Dimensional Titanium Mesh

Abstract

Functional and aesthetic reconstruction after wide decompressive craniectomy directly correlates with subsequent quality of life. Advancements in the development of biomaterials have now made three-dimensional (3-D) titanium mesh a new option for the repair of skull defects after craniectomy. The purpose of this study was to review aesthetic and surgical outcomes and complications of patients who had skull defects repaired with 3-D titanium mesh. The records of 40 adult patients (31 unilateral craniectomies and 9 bilateral craniectomies) who underwent a computer-assisted designed titanium mesh implant at a university hospital from January 2008 to January 2010 were retrospectively reviewed. Aesthetic outcomes, cranial nerve V and VII function, and complications (hardware extrusions, meningitis, osteomyelitis, brain abscess, and pneumocephalus) were evaluated. The craniofacial symmetry, implant stability, and functional outcomes were excellent for all patients. No patients had trigeminal or facial dysfunction. All had excellent cosmetic results as measured by post-reduction radiographs and personal and family perceptions of the forehead contour. Two patients had delayed wound healing and subsequent subclinical wound infections, which resolved after treatment with antibiotics for 2 weeks. Craniofacial skeletal reconstruction with 3-D titanium mesh results in excellent forehead contour and cosmesis, and subsequently a better quality of life with few complications. Titanium mesh reconstruction offers a favorable alternative to other graft materials in the repair of large skull defects.

3-D titanium mesh reconstruction of defective skull after frontal craniectomy in traumatic brain injury

“…Following implantation, the aesthetic, radiological, and functional outcomes of all patients were good. Postoperative complications, such as wound pain and infection, were similar to those previously reported in the F-T-P region [15], and no other serious postoperative complications were encountered. At the present mean follow-up of nearly 29 months (range 19-33 months), no headaches, wound infections, or intracranial/ hardware complications have been noted.…”

“…No infection occurred in any of these patients, which prompted the authors to suggest that the single-stage titanium mesh reconstruction technique is superior to the conventional staged approach [24]. Moreover, our previously published data provided evidence that bilateral titanium cranioplasty following F-T-P DC could be completed in a single operation [15]. Furthermore, results from the current work show that the use of a one-piece implant in a single operation is also applicable to patients with bifrontal skull defects.…”

“…This belief was based on the assumption that the risk of infection would increase if skull injuries were repaired in a single stage [15]. However, recent clinical reports have challenged these assumptions in cases where titanium mesh is used.…”

“…Brain computed tomographic (CT) scans and CAD/CAM of 3-D titanium mesh for F-T-P skull defects were as described in our previous study [15]. Briefly, each patient received a CT scan on the area of the brain representing a slice (1.25 mm thick) from the base of the skull to convexity (including the region of the skull defect).…”

“…For example, we previously presented a quantitative analysis of craniofacial symmetry based on the cranial index of symmetry (CIS) following craniofacial skeletal reconstructions using polymethyl methacrylate (PMMA) [1] and titanium cranioplasty [15]. However, little is currently known about the use of CAD/CAM-fabricated implants in the repair of skull defects following frontal DC.…”