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At least 109 records · Page 6Linked to original sources

PubMed1985

Preformed polymethylmethacrylate cranioplasties: report of 45 cases.

In 45 patients a preformed polymethylmethacrylate (PMMA) cranioplasty prosthesis was inserted. The cranial defects mainly were caused by trauma, removal of tumour and secondary infection of bone after intracranial operation. Several broken peroperatively cold-cured acrylic plates were replaced by preoperatively molded PMMA plates. The longest follow-up was seven years and the shortest four months; the average was 39 months. The size of the defect ranged from 6 cm2 to 175 cm2. The average age at operation was 33 years; the youngest patient was one year, the oldest 74 years. There were no acute postoperative complications. Two plates had to be removed nearly one year after insertion. Both patients had a long history of chronic bone infection before the PMMA cranioplasty was performed. The technical details will be described; the advantages of the method will be discussed.

Adolescent↗

PubMed2002

Design and manufacturing of cranioplasty implants by 3-axis cnc milling.

Although various techniques and materials have been used for making cranioplasty implants, personalized cranioplasty implants are high in cost because of expensive materials and production technology, long design and manufacturing time, and intensive labor use. This research was a part of our research project in ASEAN countries to investigate feasible technical solutions of minimizing the implant cost based on available production technologies in the region. The use of 3-axis CNC (Computer Numerical Control) milling techniques for making molds to fabricate PMMA implants was successfully investigated. With the development of a design support program bridging between Computer Aided Design (CAD) and Medical Image Processing (MIP) system, the time for geometrical modeling of implants and molds was reduced to half a day. The machining time to complete a mold was about 5 to 6 hours; and it took maximal 2 hours to fabricate an implant with self-curing PMMA and 3 and half hours for fabricating an implant with heat-curing PMMA. The cost of implants is acceptable for the ASEAN region.

Computer-Aided Design↗

PubMed2000

Custom cranioplasty using stereolithography and acrylic.

Numerous methods of cranioplasty have been described. Customization and prefabrication have been reported to reduce operating time and improve cosmesis. An original technique for the manufacture of customized cranioplastic implants has been developed and tested in 30 patients.Thirty patients requiring cranioplasties were selected. Data acquired from computed tomography (CT) were used to manufacture exact plastic replicas (biomodels) of craniotomy defects and master cranioplastic implants using the rapid prototyping technology of stereolithography (SL). The three-dimensional (3D) imaging techniques of mirroring and interpolation were used to extrapolate on existing anatomy to design the master implants. The master implants were hand finished to fit the defect in the corresponding cranial biomodel exactly and were then used to create a cavity mould. The mould was used to cast thermally polymerised custom acrylic implants. The surgeons reported that the customized implants reduced operating time, afforded excellent cosmesis and were cost effective. The patients reported that the opportunity to see the biomodel and implant preoperatively improved their understanding of the procedure. Two complications were noted, one infection and one implant required significant trimming. The simultaneous manufacture of the master implant (male) and biomodel (female) components from SL allowed custom accurate implants to be manufactured. Disadvantages identified were the time required for computer manipulations of the CT data (up to 2 h), difficulty in assessing the accuracy of the computer generated master as a 3D rendering, the potential for SL parts to warp, manufacturing time (minimum 2 days) and the cost of approximately $1300 US per case ($1000 for the SL biomodel and $300 for the acrylic casting).

Humans↗

PubMed1980

[Cranioplasty after extensive decompressive craniotomy with displacement of the cerebral hemisphere. CA analysis (author's transl)].

Cosmetic aspects and protection of the brain from mechanical injuries are the most common indications for the repair of traumatic and operative cranial defects. We suggest two additional indications: Cranioplasty is not only important in the treatment of space-occupying fluid cysts, but also in preventing or overcoming hemisphere collapse with its resultant displacement of the midline structures. This complication was almost exclusively found in patients subjected to extensive lateral craniotomies and also led to psycho-organic syndromes with disturbances of mood and drive. In few cases a crippling hemiparesis and epileptiform fits were also present. The recovery of the patients was almost complete after the repair of the cranial defect. Clinical improvement was due to restitution of physiological intracranial pressure state and re-expansion of the cerebral hemispheres as could be shown by computer tomography. The operative procedure of auto-, homo- and heteroplastic cranioplasty is described, with particular emphasis on the new technique with acrylic plastic, developed by the authors.

Acrylic Resins↗

PubMed1985

An improved method for stainless steel wire mesh cranioplasty.

A method for stainless steel wire mesh cranioplasty is described. The method has proved simple and quick. Cosmetic results have been very good and no complications have been observed so far. This method seems particularly suitable in very large skull defects. It seems to reduce the incidence of the major complications of the wire mesh cranioplasties, viz. lifting of the margins, depression of the prosthetic vault and electrolytic interference with the circulating fluids.

Alloys↗

PubMed1998

Stereolithography for posterior fossa cranioplasty.

Posterior fossa cranioplasty has been suggested for improvement of neurological symptoms following craniectomy. However, there is no particular recommendation in the literature about techniques for prosthesis manufacture and implantation. We report our experience using rapid prototyping technology and stereolithography for pre-surgical implant design and production of cranioplasties.

Case Reports↗

PubMed2000

Applications of fast-setting hydroxyapatite cement: cranioplasty.

A variety of autogenous and synthetic materials have been used to repair cranial defects resulting from traumatic and iatrogenic causes. In theory, the ideal material should be readily available and safe. It should adequately protect the underlying central nervous system, resist cerebrospinal fluid fistula formation, and be easily contoured. One promising synthetic biomaterial that has been used for cranioplasty is hydroxyapatite cement. This biomaterial has successfully restored cranial contour in most patients in whom it has been used; however, difficulties have arisen because of the material's prolonged water solubility. When exposed to cerebrospinal fluid or blood, inadequate setting of the cement occurs, resulting in loss of its structural integrity. This problem can be alleviated with the use of fast-setting hydroxyapatite cement, which hardens 6 to 12 times faster than the traditional cement. We present, to the best of our knowledge, the first series of the use of this material in 21 patients requiring cranioplasty. The advantages and limitations of fast-setting hydroxyapatite cement will be discussed.

Adult↗

PubMed1999

A prospective study of computer-aided design and manufacture of titanium plate for cranioplasty and its clinical outcome.

The use of computerized three dimensional imaging and automated milling of models to produce accurate titanium plates for the reconstruction of craniofacial defects is described. A total of 148 patients have had extensive calvarial defects repaired using this (computer aided design and manufacture) technique developed in our unit. Of these, 141 were repaired secondarily (delayed cranioplasty), whilst seven were repaired immediately following craniectomy (single stage cranioplasty). All cases were assessed for accuracy of fit, restoration of natural skull contour and aesthetics. Seventy-two patients were reviewed after 1 year to determine the effect on adverse preoperative symptoms. Of the plates 97% had an excellent or good intraoperative fit. The modal insertion time was only 15 minutes. Postoperatively 98% resulted in the restoration of natural skull shape and symmetry. After 1 year, 82% of patients had complete resolution or diminution in severity of the adverse symptoms. A staphylococcus infection necessitated the temporary removal of one plate.

Adolescent↗

PubMed2001

Long-term follow-up of dynamic cranioplasty for brachycephaly--non-syndromal bicoronal synostosis.

We followed up 10 patients whose non-syndromal bicoronal synostosis had been operated on with a dynamic cranioplasty technique developed by this craniofacial unit in 1992. With this technique, the growth of the brain is redirected in an anteroposterior direction as wire-mediated compression and restraint are exerted on the transverse and vertical dimensions of the skull. The mean operating time was 160 minutes (range 120-275) and mean stay in the intensive care unit was 36 hours (range 23-58). There was no operative mortality and few complications. The surgical results were assessed objectively by analysis of cephalometric tracings. The mean (SD) cephalic index was 87.6 (4.9) preoperatively and 77.7 (1.8) postoperatively (p = 0.001). The modified Whitaker scale was used as a subjective outcome measurement, and nine patients were classified as Whitaker grade 1 (no additional surgery). One patient required additional intracranial surgery. A questionnaire was sent to all families to obtain an additional subjective measurement of outcome. Parents' satisfaction was high. We conclude that dynamic cranioplasty is a safe and efficient operation for treatment of brachycephaly.

Cephalometry↗

PubMed1994

Rigid mesh fixation for alloplastic cranioplasty.

The evolution of cranioplasty techniques is described. A cranioplasty technique is presented that incorporates metallic mesh within acrylic and utilizes the principle of rigid fixation to avoid micromotion at the alloplastic-bone interface. Six procedures have been completed without complications.

Humans↗

PubMed2003

Clinical outcome in cranioplasty: critical review in long-term follow-up.

Various materials have been proposed for cranial reconstruction. Bone autograft and alloplasts such as polymethylmethacrylate (PMMA) and hydroxyapatite (HA) cement are most commonly used at the present time. Patients submitted for cranioplasty were evaluated. The prognostic factors influencing the results and the outcome were analyzed. Three hundred twelve patients who had 449 procedures performed by a single surgeon to reconstruct a calvarial deformity between 1981 and 2001 were studied. Post-tumor resection deformity was the main reason for cranioplasty (32.4%). Bone graft was the material of choice (69.5%). The main surgical site was the frontal bone (53.2%). Complications were observed in 23.6% of cases and were responsible for the least satisfactory results (P > 0.001), with infection and material exposure being the most critical complications. The eventual outcome was considered good in 91.8% of cases. The use of HA cement was associated with the worst results (P > 0.001). Bone grafts showed a high grade of partial resorption and required further surgery for correction. Multiple surgical procedures were correlated with a high rate of complications and an unsatisfactory outcome. Bone graft and PMMA are still the best materials in calvarial reconstruction. Even though HA cement is an osteoconductive material, it seems to induce what appears to be an immunoguided delayed inflammatory reaction that leads to thinning of the skin and exposure of the material, making secondary repair difficult. Before deciding which reconstructive option to use, a careful evaluation of the patient in terms of diagnosis, number of previous surgeries, and surgical site should be undertaken. If this is adopted, good results and a satisfactory outcome can be achieved on long-term follow-up.

Adolescent↗

PubMed2005

Biomechanical testing of alloplastic PMMA cranioplasty materials.

Alloplastic cranioplasty techniques using polyfmethylmethacrylate (PMMA) are a common method of restoring lost cranial bone. Numerous compositions of PMMA exist for this application, using either intraoperatively cured solid compositions or preoperatively fabricated porous custom implants. Although all of these PMMA materials feel solid by palpation, the amount of cranial protection that they provide has never been precisely evaluated. Whether differences exist between the differing PMMA cranioplasty materials likewise is unknown. An impact resistance test was performed on uniform-size blocks of differing PMMA materials of representative cranial thickness using American Society of Testing and Materials (ASTM) method D 3029-78. Based on mean failure weights of 3.9 lb (Cranioplast), 4.2 lb (Cranioplexx), and 4.0 lb (HTR polymer), all of these materials are comparatively the same in impact resistance. Precured porous PMMA, despite having 30% to 40% less material, offered no less impact resistance. Based on projections to cranial bone, PMMA materials appear to offer protection similar to that of native osseous tissue.

Biomechanical Phenomena↗

PubMed2006

Automatic hole repairing for cranioplasty using Bézier surface approximation.

Cranioplasty is the procedure that repairs holes or defects in the skull with cranial implants. When the bone from the hole is missing, damaged, or infected, the defect needs to be covered with an artificial plate to protect the brain. In this paper, a hole-repairing algorithm is developed to aid in shaping artificial plates for Cranioplasty, by describing a method for filling holes in defective biomodels with unstructured triangular surface meshes or in stereo-lithography format. The resulting patching meshes interpolate the shape and density of the surrounding mesh. The steps in repairing a hole include hole identification, hole triangulations using Genetic Algorithm optimization, and a customized advancing-front meshing technique using surface approximations based on a Quartic Bézier patch/surface.

Algorithms↗

PubMed1991

Cranioplasty, vertebral body replacement, and spinal fusion with tobramycin-impregnated methylmethacrylate.

A prospective analysis of cranioplasty, vertebral body replacement, and spinal fusion using tobramycin-impregnated methylmethacrylate in 65 patients is presented. Cranioplastic methacrylate (1 packet) was mixed with 1.2 g of powdered tobramycin and placed into the desired location. The polymer was irrigated with bacitracin until it became solid. All patients received prophylactic medication with intravenously administered nafcillin and cephalosporin perioperatively and for 48 hours postoperatively. The follow-up time ranged from 7 to 57 months (mean, 32.2 months). Serum tobramycin levels remained below 0.5 microgram/ml in all patients tested, regardless of the time interval. Blood urea nitrogen and creatinine levels remained within normal limits in all patients, and there has been no nephrotoxicity or ototoxicity. There has been 1 infection among the 65 patients (1%) to date. It occurred in a patient who had a previously treated local infection. Cranioplasty, vertebral body replacement, or spinal fusion with tobramycin-impregnated methylmethacrylate is safe and may reduce the incidence of infection.

Bacterial Infections↗

PubMed1998

Cranioplasty with neovascularized autogenous calvarial bone.

We have presented two cases of cranioplasty with neovascularized autogenous calvarial bone. A surgical procedure applying the principle of flap prefabrication has been applied to the preservation of autogenous calvarial bone obtained during external cranial decompression. The rectus abdominis muscle flap was elevated. A subcutaneous pocket was prepared for preservation of calvarial bone integrated with the rectus abdominis muscle. The outer cortex of calvarial bone was removed partially by bone chiseling. The muscle flap was attached to the bone graft by means of two holes on the bone by suture. The calvarial bone, grafted onto the rectus abdominis muscle flap, was inserted into the subcutaneous pocket. Several weeks later, the neovascularized calvarial bone flap was dissected along with inferior epigastric pedicle. Cranioplasty was performed using the bone element of the flap. Revascularization was achieved by anastomosing the inferior epigastric vessels to the temporal vessels. The postoperative films demonstrated marked radiolucency at the borders of the flap, although bone scan documented that the flap was vascularized. We speculate that the transferred bony segment was not completely vascularized.

Adult↗

PubMed2006

Cranioplasty with subcutaneously preserved autologous bone grafts.

BACKGROUND: The efficacy of reconstructing a cranial defect with the craniectomy bone graft (bone flap) banked in a subcutaneous pocket of the abdominal wall after emergency decompressive craniotomy was evaluated. METHODS: A retrospective study was performed on 53 of 65 consecutive patients who underwent emergency decompressive craniectomy and bone graft placement in the abdominal wall and survived to graft replacement. Clinical outcome after graft replacement was determined by the adequacy of the recovered craniectomy graft to achieve satisfactory reconstruction, the incidence of infection and the need for revisional surgery. RESULTS: Forty-nine of the 53 patients (92 percent) in whom delayed autogenous graft replacement was attempted achieved a satisfactory one-stage reconstruction. In 42 of these 49 patients, autogenous graft replacement alone was performed. In eight patients it was necessary to supplement the graft with alloplastic material to achieve desired contour. One patient who underwent reconstruction with the autogenous bone graft alone, underwent late revision cranioplasty to improve contour. There were three infections. One graft was found infected in the abdominal pocket at retrieval. Two were lost to operative infection after graft replacement. Histology of two stored grafts performed after abdominal pocket retrieval demonstrated a mixture of necrotic and newly formed woven bone. A bone scan performed 1 year after graft replacement showed radionuclide activity of the graft almost identical to that of intact neighboring bone. CONCLUSIONS: Subcutaneous storage preserves viability of portions of autogenous bone grafts. Cranioplasty performed with a subcutaneously preserved craniectomy graft has a low revision rate.

Abdomen↗

PubMed2005

Automatic hole repairing for cranioplasty using Bézier surface approximation.

Cranioplasty is the procedure that repairs holes or defects in the skull with cranial implants. When the bone from the hole is missing, damaged, or infected, the defect needs to be covered with an artificial plate to protect the brain. In this study, a hole-repairing algorithm is developed to aid shaping artificial plates for cranioplasty by describing a method for filling holes in defective biomodels with unstructured triangular surface meshes or in stereolithography format. The resulting patching meshes interpolate the shape and density of the surrounding mesh. The steps in repairing a hole include hole identification, hole triangulations using genetic algorithm (GA) optimization, and a customized advancing-front meshing technique using surface approximations based on a Quartic Bézier Gregory patch.

Algorithms↗

PubMed2002

Acrylic cranioplasty and axial pattern flap following calvarial and cerebral mass excision in a dog.

A 4 kg Chihuahua was presented with seizures and a large mass on his dorsal cranium. The mass had regrown after two previous attempts to remove it. Histological examination had shown the mass to be a multilobular osteochondroma (osteochondrosarcoma). A CT scan revealed destruction of the dorsal cranial bones by the mass and compression of cerebral cortex. A craniotomy was performed to excise the mass and attached skin, leaving a large deficit of calvarial bone and skin. A cranioplasty was performed in situ, using polypropylene mesh and polymethyl methacrylate. A caudal auricular axial pattern flap was placed directly over the cranioplasty to fill the skin defect. This unusual reconstruction resulted in good recovery, function and cosmetic effect, although tumour regrowth was seen within the cerebral cortex.

Animals↗