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Spontaneous fracture of a titanium mesh cranioplasty implant in a child: A case report

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World Journal of Clinical Cases 2023年第7期11卷 1593-1599页

作者： Rui Zhang Zhe Gao Yong-Jie Zhu Xin-Fa Wang Gang Wang Jun-Ping He Department of Neurosurgery Nanjing Children's HospitalNanjing Medical UniversityNanjing 21000Jiangsu ProvinceChina

BACKGROUND Titanium mesh cranioplasty is often performed after decompressive *** fracture of the titanium prosthesis is an extremely rare postoperative ***,we report a 10-year-old boy who presented with a spontaneous fracture of titanium mesh without antecedent head *** SUMMARY A 10-year-old boy presented with a 1-wk history of a tender bulge over the left temporo-parieto-occipital *** had undergone a temporo-parieto-occipital titanium mesh cranioplasty 26 mo *** denied antecedent head *** tomography disclosed a perpendicular fissure in the titanium mesh,suggesting a diagnosis of spontaneous titanium mesh *** underwent a second temporo-parieto-occipital cranioplasty and made an uneventful ***-dimensional modeling and finite element analyses were used to explore potential risk factors of titanium mesh *** We report a case of spontaneous fracture of a titanium mesh cranioplasty *** current case and literature review indicate that titanium mesh implants should be well-anchored to the base of bony defects to prevent fatigue-induced fractures.

关键词： cranioplasty Prosthesis fracture Spontaneous fracture Titanium Case report

cranioplasty after Decompressive Craniectomy Caused an Intracerebral Hemorrhage: A Case Report

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Modern Plastic Surgery 2015年第3期5卷 28-33页

作者： Takayuki Okumoto Tomito Oji Kazuo Kishi Department of Plastic and Reconstructive Surgery Fujita Health University School of Medicine Aichi Japan Department of Plastic and Reconstructive Surgery Sakura Medical Center Toho University School of Medicine Chiba Japan Department of Plastic and Reconstructive Surgery Keio University School of Medicine Tokyo Japan

Decompressive craniectomy is a common practice for patients with intracranial hypertension. Secondary rigid structural reconstruction following craniectomy can release the effects of atmospheric pressure on the brain, and the brain can become dilated. Although some cases with complications induced by cranioplasty, such as intracranial hematoma, have been reported, no clinical cases with intracerebral hemorrhage after rigid reconstruction have been reported. This case report describes a 39-year-old man with a skull defect following clipping with simultaneous decompressive craniectomy for a subarachnoid hemorrhage. About 25 months later, cranioplasty using a custom-made hydroxyapatite (HAP) ceramic implant was performed. Immediately after the operation, intracerebral hemorrhage was detected on the opposite side by computed tomography (CT). However, there were no physical or neurological findings, the hematoma was completely absorbed within 3 weeks postoperatively, and the skull retained a good shape. This case suggests that rigid reconstruction of a skull defect can influence intracranial conditions, and early postoperative CT is important to detect complications.

关键词： cranioplasty Rigid Reconstruction Skull Defect Intracerebral Hemorrhage Decompressive Craniectomy

cranioplasty of Calvarial Skull Defects: A Comparative Study between Using Three Dimensional Custom-Made Cranioprostheses versus Hand-Made Bone Cement in Restoring Skull Configuration

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Open Journal of Modern Neurosurgery 2019年第3期9卷 314-326页

作者： Mohamed Gaber Abdel Tawab Mostafa A. Latif, Ashraf Abdel Latif Osman Fayoum University Fayoum Egypt

Introduction: cranioplasty is the surgical repair of a bony defect or deformity in the skull that is caused after cranial surgery or trauma. It carries cosmetic and protective benefits. Many types of materials are allowed. The subject of this study is to compare the outcome of two different manufacturing processes in reconstruction of calvarial skull defects by using 3D custom-made cranioprostheses versus hand-made bone cement implants. Patient and Methods: This is a prospective comparative study conducted on 20 patients of calvarial skull defects of different etiologies, sites and sizes, admitted in the neurosurgical departments of Cairo and Fayoum Universities in the period from August 2017 to February 2018. Patients are divided into two study groups: (group 1) 10 patients operated upon by 3D custom-made implant;(group 2) operated upon by hand-made bone cement implant. Statistical Analysis Used: Mann-Whitney test and Chi-square test. Results: Craniotomy using 3D custom-made implants gives better results than using bone cement in the functional restoration of skull shape and cranial protection with shorter operative time and less rate of postoperative complications. There is no statistically significant difference between the two study groups regarding cosmetic outcome. Conclusion: 3D custom-made implant is recommended for large and complex skull defects. Further and large studies might be needed.

关键词： cranioplasty Custom-Made Implant Bone Cement

cranioplasty using polymethylmethacrylate cement following retrosigmoid craniectomy decreases the rate of cerebrospinal fluid leak and pseudomeningocele

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Cranioplasty using polymethylmethacrylate cement following r...

Autogenous Bone Graft versus Artificial Substitutes in cranioplasty

2018年浙江省神经外科学学术年会

作者：陈毅力欧昌江 Jun Mo Shenghu Wang Shiying Gai Ruxin Xing Bo Wang Chunlai Wu 浙江大学医学院附属第四医院神经外科 Department of Neurosurgery The Fourth Affiliated Hospital Zhejiang University School of Medicine

Objective: Cerebrospinal fluid(CSF) leak frequently occurs after retrosigmoid craniectomy. The present study investigated the effects of cranioplasty using polymethylmethacrylate(PMMA) cement to reduce the incidence of CSF leak following retrosigmoid craniectomy as compared to the autologous bone flap combined with titanium *** and Methods: 243 patients underwent surgeries via retrosigmoid approach for microvascular decompression or tumor resection. Of these, 107 patients underwent craniotomy, and incomplete cranioplasty was performed with autologous bone flap fixed with titanium plates, while 136 patients underwent craniectomy and complete cranioplasty was performed with PMMA cement. Variables including the incidence of CSF leak, pseudomeningocele formation, wound infection, rejection reaction were compared retrospectively based on the clinical data between the two ***: In the autologous bone group, 9 patients had postoperative CSF leaks, and 11 patients had pseudomeningoceles, while 3 CSF leaks and 2 pseudomeningoceles were found in the PMMA group. Statistical analysis showed that PMMA significantly decreased the incidence of postoperative CSF leaks(p=0.03) and pseudomeningocele formation(p=0.002). Wound infections were observed in 2 and 1 patients between the autologous bone and PMMA group, respectively, which did not differ significantly(p=0.58). None of the patients in both groups developed a rejection reaction of artificial ***: Complete cranioplasty with PMMA cement following retrosigmoid craniectomy could decrease the incidence of CSF leak and pseudomeningocele formation as compared to the autologous bone flap combined with titanium plates. Thus, PMMA cement is preferable for bone reconstruction with excellent biocompatibility and without increasing the rate of wound infection.

关键词： Retrosigmoid Craniectomy Microvascular Decompression cranioplasty Polymethylmethacrylate CSF leak Pseudomeningocele

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Open Journal of Modern Neurosurgery 2019年第3期9卷 338-355页

作者： Hassan Hassan Alaeddin Ali Ahmad Abdalla Neurosurgery Department Assiut University Assiut Egypt

cranioplasty is a routine procedure in neurosurgery. However, it has a high postoperative complication rate up to 40%. The lack of good prospective studies and the small number of patients who receive artificial substitutes make it difficult to choose between different materials and the decision is mostly based on subjective or economic reasons. The main goal of this study was to compare the most common complications related to the implant within the first year after implantation. Methods: This prospective randomized clinical study has been carried out on 32 patients with cranial defects of different etiologies, sites and sizes which have been operated in Assiut University Hospital from January 2016 to January 2017. The patients were randomized into two groups: Autologous and Artificial group. Each group has 16 patients. Results: The overall complication rate in autologous group was found to be (25%) and in artificial group (37.5%). Infection in autologous group was found in (6.25%), in artificial group was found in (12.5%). Bone resorption was found in (12.5%). For epidural hematoma and wound dehiscence each has a rate of (6.25%). Poor cosmetic result in (18.75%) of artificial group. Conclusion: cranioplasty is not without complications. However, good decision making, good timing and proper surgical techniques can provide excellent results. Primary titanium mesh cranioplasty should be considered especially in young adult patients with traumatic aetiology of bone defect.

关键词： cranioplasty Titanium Mesh Autogenous Bone Bone Cement Medpor

Experimental Study on cranioplasty with Autocranial Bone Granules

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Journal of Medical Colleges of PLA 1987年第1期 55-58页

作者：张洪海程德清张素娟李少卿 Department of Pathology First Medical College of PLA Guangzhou Department of Neurosurgery Nanfang Hospital.First Medical College of PLA

A piece of rabbit parietal bone which was taken out by trephine wasground to granules and spread over the cranial *** the end of the 4thweek,bone trabeculae and osteoid tissue developed;at the end of the 20th weekthere was bone healing with outer and inner tables and bone marrow *** new bone kept a harmonious curvature with the surrounding skull and noexcessive bone formation that might compress the pia mater vessels nor brainabnormalities were found,the potential subgaleal space was gradually restored.

关键词： cranioplasty autocranial bone granules parietal bone rabbits

Traumatic Acute Subdural Hematoma: Treatment by Evacuation with Decompressive Craniotomy and cranioplasty, Case Series and Surgical Outcome Analysis

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Open Journal of Modern Neurosurgery 2018年第3期8卷 331-341页

作者： Ahmed. M. Elshanawany Abdelhakeem A. Essa Department of Neurosurgery Faculty of Medicine Assiut University Assiut Egypt

Background: Acute subdural hematoma (ASDH) is considered the most common traumatic brain mass lesion. Its prognosis is still grave despite the improvements in treatment modalities. Its mortality rate was reported to be around 60% until the 1990s. In the last decade, ASDH mortality rate was reduced to the level of 20% - 40%. Standard treatment to decrease intracranial tension via hematoma evacuation is associated with decompressive craniotomy and followed by ICU management. Objective: To evaluate the outcome and prognostic factors in patients of acute subdural hematoma treated by surgical evacuation and decompressive craniotomy. Also, outcome of cranioplasty by repositioning of patients own bone or by synthetic mesh methods is evaluated. Patients and Methods: It is one year retrospective study. It was conducted on 53 patients, in trauma unit, Assiut university hospitals. We report time lag between trauma and performed surgery, initial Glasgow coma scale (GCS), age, sex and presence of other intracranial pathologies. Outcome assessment is based on Glasgow outcome scale (GOS) and fol-low-up extended for 6 months. We include those patients with only (isolated) head trauma, shift of midline more than 5 mm in CT brain. We excluded pa-tients with GCS 3 and fixed dilated pupils as well as patients with GCS higher than 12. We did decompressive craniotomy and duraplasty in all patients. Bone flap of decompressive craniotomy is situated in the abdomen. All func-tionally recovered patients were submitted for cranioplasty with either re-placing patient own bone or by Titanium mesh. Results: We had 39 males and 14 females. Age ranged between 7 and 65 years old. 23 deaths, 10 persis-tent vegetative state, 10 severe disability, 8 moderate disability and 2 good recovery. The outcome analysis was based on 6 month follow-up. Conclu-sion: Acute subdural hematoma is a very serious condition. Mortality and morbidity is intimately related to GCS on admission. Presence of associated cerebr

关键词： Acute Subdural Hematoma Hematoma Evacuation Decompressive Craniotomy cranioplasty

Investigation of operative skills and cranioplasty complications using biomimetic bone(nano-hap/collagen composites)

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Translational Neuroscience and Clinics 2018年第2期4卷 131-140页

作者： Tuoyu Chen Lin Chen Xin Pan Chaoqiang Xue Qinglin Zhang Yuqi Zhang Department of Neurosurgery Tsinghua University Yuquan Hospital

The aim of the current study was to investigate the operation skills and complications associated with skull defect repair using biomimetic bone(nano-hap/collagen composites). Clinical data from 45 patients with skull defects who underwent cranioplasty with biomimetic bone from January 2014 to January 2017 were retrospectively *** patients participated in follow-up visits from 8 months to 3 years postoperatively. Cranioplasties were successful in all 45 patients,but 17 patients(20 cases) presented various complications, including subcutaneous hydrops(14 cases), biomimetic bone fixation loosening(4 cases), wound indolence(1 case), and biomimetic bone fragmentation(1 case). cranioplasty complications in surgeries using biomimetic bone are more common in children than in *** the physicochemical properties of biomimetic bone and the normal developmental process in children, as well as mastering the appropriate surgical skills and implementing the effective preventive measures are all ways to reduce and control the incidence of complications associated with biomimetic bone cranioplasty.

关键词： biomimetic bone skull defect cranioplasty complications

Skull repair materials applied in cranioplasty: History and progress

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Translational Neuroscience and Clinics 2017年第1期3卷 48-57页

作者： Qingsheng Yu Lin Chen Zhiye Qiu Yuqi Zhang Tianxi Song Fuzhai Cui Beijing Allgens Medical Science and Technology Co. Ltd. Department of Neurosurgery Tsinghua University Yuquan Hospital School of Materials Science and Engineering Tsinghua University

The skull provides protection and mechanical support, and acts as a container for the brain and its accessory organs. Some defects in the skull can fatally threaten human *** efforts have been taken to repair defects in the skull, among which cranioplasty is the most prominent technique. To repair the injury, numerous natural and artificial materials have been adopted by neurosurgeons. Many cranioprostheses have been tried in the past decades, from autoplast to bioceramics. Neurosurgeons have been evaluating their advantages and shortages through clinical practice. Among those prostheses, surgeons gradually prefer bionic ones due to their marvelous osteoconductivity,osteoinductivity, biocompatibility, and biodegradability. Autogeneic bone has been widely recognized as the "gold standard" for renovating large-sized bone defects. However, the access to this technique is restricted by limited availability and complications associated with its use. Many metal and polymeric materials with mechanical characteristics analogous to natural bones were consequently applied to cranioplasty. But most of them were unsatisfactory concerning osteoconductiion and biodegradability owe to their intrinsic properties. With the microstructures almost identical to natural bones, mineralized collagen has biological performance nearly identical to autogeneic bone, such as osteoconduction. Implants made of mineralized collagen can integrate themselves into the newly formed bones through a process called "creeping substitution". In this review, the authors retrospect the evolution of skull repair material applied in cranioplasty. The ultimate skull repair material should have microstructure and bioactive qualities that enable osteogenesis induction and intramembranous ossification.

关键词： skull defect cranioplasty skull repair materials mineralized collagen osteogenesis