Polyetheretherketone Implants for the Repair of Large Cranial Defects

Rosenthal, Guy; Ng, Ivan; Moscovici, Samuel; Lee, Kah K.; Lay, Twyila; Martin, Christine; Manley, Geoffrey T.

doi:10.1227/neu.0000000000000477

Cited by 112 publications

(73 citation statements)

References 20 publications

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“…A recent international, multiinstitutional report of 66 PEEK prostheses demonstrated an infection rate of 7.6%. 21 The postcranioplasty infection rate among 151 PEEK implants in our series was 6%, and, as in other studies, suggests that synthetic prostheses have infection rates similar to those with ABFs. 4,14,19,23,25,[27][28][29] Most important in our results is the favorable comparison between protocols A and B as regards the reimplantation of +ABFs despite intraoperative bone cultures of skin flora.…”

Section: Discussionsupporting

confidence: 86%

“…Such timing is favored by some centers given reports of functional improvement after early cranioplasty. 1,7,11,21 Our data suggest that the ideal time for early cranioplasty, if desired, is probably between 14 and 30 days to balance the risk of infection with neurocognitive improvement since interrupting the wound healing process earlier than 14 days seems to predispose to subsequent wound complications.…”

Section: Discussionmentioning

confidence: 90%

See 1 more Smart Citation

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Morton¹,

Abecassis²,

Hanson³

et al. 2016

JNS

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Predictors of infection afterobJective The authors' aim was to report the largest study on predictors of infection after cranioplasty and to assess the predictive value of intraoperative bone flap cultures before cryopreservation. methods They retrospectively examined all cranioplasties performed between March 2004 and November 2014. Throughout this study period, the standard protocol during initial craniectomy was to obtain a culture swab of the extracted autologous bone flap (ABF)-prior to its placement in cytostorage-to screen for microbial contamination. Two consecutive protocols were employed for the use and interpretation of the intraoperative swab culture results: A) From March 2004 through June 2013, any culture-positive ABF (+ABF) was discarded and a custom synthetic prosthesis was implanted at the time of cranioplasty. B) From July 2013 through November 2014, any ABF with a skin flora organism was not discarded. Instead, cryopreservation was maintained and the +ABF was re-implanted after a 10-minute soak in bacitracin irrigation as well as a 3-minute soak in betadine. results Over the 10.75-year period, 754 cranioplasty procedures were performed. The median time from craniectomy to cranioplasty was 123 days. Median follow-up after cranioplasty was 237 days for protocol A and 225 days for protocol B. The overall infection rate after cranioplasty was 6.6% (50 cases) occurring at a median postoperative Day 31. Staphylococcus spp. were involved as the causative organisms in 60% of cases. Culture swabs taken at the time of initial craniectomy were available for 640 ABFs as 114 ABFs were not salvageable. One hundred twenty-six (20%) were culture positive. Eighty-nine +ABFs occurred during protocol A and were discarded in favor of a synthetic prosthesis at the time of cranioplasty, whereas 37 +ABFs occurred under protocol B and were reimplanted at the time of cranioplasty. Cranioplasty material did not affect the postcranioplasty infection rate. There was no significant difference in the infection rate among sterile ABFs (7%), +ABFs (8%), and synthetic prostheses (5.5%; p = 0.425). All 3 +ABF infections under protocol B were caused by organisms that differed from those in the original intraoperative bone culture from the initial craniectomy. A cranioplasty procedure ≤ 14 days after initial craniectomy was the only significant predictor of postcranioplasty infection (p = 0.007, HR 3.62). coNclusioNs Cranioplasty procedures should be performed at least 14 days after initial craniectomy to minimize infection risk. Obtaining intraoperative bone cultures at the time of craniectomy in the absence of clinical infection should be discontinued as the culture results were not a useful predictor of postcranioplasty infection and led to the unnecessary use of synthetic prostheses and increased health care costs.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 90%

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Morton¹,

Abecassis²,

Hanson³

et al. 2016

JNS

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“…Jalbert et al (Jalbert et al, 2014) operated on five patients with fronto-orbital defects in a single-step procedure for resection and reconstruction with a navigation device and PEEK PSI, with very good results and no major complications; this was similar to the experience of Kim et al (Kim et al, 2009), who reported four cases of maxillofacial defects. Rosenthal et al (Rosenthal et al, 2014) describe their experience with PEEK PSI in 66 cranioplasties at three different institutions. These authors reported a complication rate comparable to that of other implants or autologous bone, with an infection rate of 7.6% and a surgical removal rate of 9.1%, with overall satisfactory esthetic results.…”

Section: Discussionmentioning

confidence: 99%

Polyetheretherketone custom-made implants for craniofacial defects: Report of 14 cases and review of the literature

Alonso-Rodríguez

Carretero

Nieto

et al. 2015

Journal of Cranio-Maxillofacial Surgery

100

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“…No CSF leak was reported. The use of an autologous bone graft reduced the risk of infection compared with prosthetic materials, such as titanium, polyetheretherketone or polymethylmethacrylate [25,26]. Currently, we still perform iliac bone harvesting.…”

Section: Perioperative Reconstructionmentioning

confidence: 99%

Internal and external spheno-orbital meningioma varieties: different outcomes and prognoses

Leroy¹,

Leroy-Ciocanea²,

Baroncini³

et al. 2016

Acta Neurochir

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The internal SOM variety exhibited a reduced total resection rate and a shorter progression-free survival (PFS). Unroofing of the optic canal extended PFS. Among grade I cases, the persistence of a negligible tumour remnant did not alter the probability of recurrence. For superior grades, radiotherapy must be administered in addition to surgery as soon as possible. SOMs require prolonged follow-up. Autologous iliac reconstruction is related to substantial morbidity and could be replaced by prosthetic bone three-dimensional reconstruction.

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Polyetheretherketone Implants for the Repair of Large Cranial Defects

Abstract: Custom-designed PEEK implants are a good option for patients with large cranial defects. The rate of complications is comparable to other implants or autologous bone. Given the large size of these defects, the aesthetic results are good.

Cited by 112 publications

References 20 publications

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Polyetheretherketone custom-made implants for craniofacial defects: Report of 14 cases and review of the literature

Internal and external spheno-orbital meningioma varieties: different outcomes and prognoses

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