Versorgung kraniofazialer Knochendefekte mit individuell vorgefertigten Titanimplantaten

Kamyszek, T; Weihe, S.; Scholz, Martin; Wehmöller, M.; Eufinger, H.

doi:10.1007/s100060100317

Cited by 16 publications

(8 citation statements)

References 12 publications

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“…While there are studies in which authors have preferred PMMA or HA as the optimal material for cranioplasty, titanium plates offer a good choice for cranioplasty based on their strength, biocompatibility, handling characteristics, and suitability for postoperative imaging techniques. 5,[21][22][23] While materials such as PMMA and HA show biocompatible and osteoconductive characteristics without significant toxic and immunogenic properties, ~ 4-13.8% of PMMA plates 26,43 and 2.6-10% of HA-based implants need replacing. 10,11,44 The best HA series with a complication rate of < 2.6% involved only cranioplasties < 6 cm following a retrosigmoid approach in most cases.…”

Section: Discussionmentioning

confidence: 99%

“…8 The infection rate of titanium implants including large skull defects ranges from 0 to 4.5%. 2,11,21,23 An often-cited reason for the removal of HA and PMMA implants is the proximity to the sinuses, a problem that exists for cranioplasty with titanium as well. In our own study, the frontal sinus was involved in 6 cases.…”

Section: Discussionmentioning

confidence: 99%

“…The CAD/CAM titanium plates offer an excellent choice for cranioplasty based on their strength, low infection rate, biocompatibility, handling characteristics, and suitability for postoperative imaging techniques, 5,[21][22][23] but they are often avoided because of their high costs. However, it may be advisable to take into account that the long-term suitability of this material could compensate its higher production costs.…”

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confidence: 99%

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Long-term results following titanium cranioplasty of large skull defects

Čabraja¹,

Klein

Lehmann³

2009

FOC

267

171

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Object 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. Methods 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. Results 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 > 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. Conclusions 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Long-term results following titanium cranioplasty of large skull defects

Čabraja¹,

Klein

Lehmann³

2009

FOC

267

171

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“…A further disadvantage of the preformed titanium blocks is their unsuitability for intraoperative reworking: if the contours are not in exact agreement or should intraoperative findings reveal a possibility of resecting a smaller bone area, for example in tumor operations, the bone resection demanded by the actual implant still must be undertaken [23]. A postoperative problem of thick titanium implants is their property of generating artifacts in imaging procedures, which reduces the sensitivity of MR-tomography in tumor diagnostics and postoperative care [23] and overradiation artifacts in the CT [36]. However, quenching in the MRT can be reduced by suitable spin frequencies [36].…”

Section: Hard Tissue Replacementmentioning

confidence: 99%

“…A postoperative problem of thick titanium implants is their property of generating artifacts in imaging procedures, which reduces the sensitivity of MR-tomography in tumor diagnostics and postoperative care [23] and overradiation artifacts in the CT [36]. However, quenching in the MRT can be reduced by suitable spin frequencies [36]. …”

Section: Hard Tissue Replacementmentioning

confidence: 99%

Biomaterials in skull base surgery

Maier

2009

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 8:Doc07; ISSN 1865-1011

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Individuelle Implantate aus biodegradierbarem Kompositmaterial zur Versorgung von Schädeldefekten

Weihe¹,

Rasche²,

Schiller³

et al. 2004

Materialwissenschaft Werkst

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Titan ist ein etabliertes Knochenersatzmaterial für die Versorgung komplexer Schädeldefekte mittels individuell geplanter CAD/CAM‐Implantate. Zur Verbesserung der durch Patientenkontrollstudien evaluierten thermischen und psychischen Belastungsfaktoren wurde in der vorliegenden Studie ein gradiertes Kompositmaterial aus Polymeren und Calciumphosphat bzw. Calciumcarbonat entwickelt. Biokompatibilitätsuntersuchungen auf Basis des ISO‐Standards 10993‐5 erlaubten zunächst die Auswahl geeigneter Materialien sowie nachfolgend die Feststellung der verbesserten pH‐Charakteristika der Kompositmaterialien gegenüber den reinen Polymeren. Für die geometrisch korrekte Herstellung der Implantate aus Kompositmaterialien wurden zwei unterschiedliche Verarbeitungsmethoden gewählt und kombiniert. Diese Implantate konnten bereits durch in‐vivo Versuche an einem eigens entwickelten Großtiermodell getestet werden und zeigten post mortem bei einem Nachbeobachtungszeitraum von zwei Monaten keine histologischen Reaktionen außerhalb der Norm und eine beginnende Knochenbildung. Klinisch ergaben sich bei den lebenden Schafen auch nach einem Zeitraum von bisher 11 Monaten keinerlei Komplikationen.

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Versorgung kraniofazialer Knochendefekte mit individuell vorgefertigten Titanimplantaten

Abstract: The use of titanium fulfils the highest demands of biocompatibility while at the same time allowing the possibility of an oncological examination using suitable turbo-spinecho-sequences in MRI.

Cited by 16 publications

References 12 publications

Long-term results following titanium cranioplasty of large skull defects

Long-term results following titanium cranioplasty of large skull defects

Biomaterials in skull base surgery

Individuelle Implantate aus biodegradierbarem Kompositmaterial zur Versorgung von Schädeldefekten

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