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Decompressive craniectomy (DC) is a life-saving surgical procedure performed to manage intracranial hypertension. Once performed, patients are obligated to undergo another surgical procedure known as cranioplasty to reconstruct the cranial defect. Cranioplasty still has one of the highest rates of infection. The factors contributing to the high rate of surgical site infection (SSI) after cranioplasty are not well established. This study aims to estimate the incidence of SSI and determine its possible risk f...
Pediatric calvarial reconstruction is challenging because of the unique anatomical and growth considerations in this population. Comparative studies evaluating current cranioplasty materials are lacking. This review addresses the knowledge gap in pediatric cranioplasty outcomes with emphasis on current materials used.
Cranioplasty is a challenge to neurosurgeons, especially considering protection of intracranial contents. In recent years, material choice for cranioplasty is still controversial, which brings complexity to this seemingly straightforward procedure. PEEK, a tough, rigid, biocompatible material, has been used more recently in cranioplasty to provide better protection. The aim of this review is to summarize the outcome of research conducted on the material for cranioplasty applications. We also reviewed the co...
Decompressive craniectomy is a life-saving procedure in the setting of malignant brain swelling. Patients who survive require cranioplasty for anatomical reconstruction and cerebral protection. Autologous cranioplasty remains the commonest practice nowadays, but partial bone flap defects are frequently encountered. The authors, therefore, seek to develop a new technique of reconstruction for cranioplasty candidate with partial bone flap defect utilizing computer-assisted 3D modeling and printing.
Severe hydrocephalic macrocephaly can cause significant morbidity in infants due to positioning difficulties, skin breakdown, and poor cosmesis. Many surgeons over the past decades have described a variety of surgical techniques of reduction cranioplasty. In this article, the authors describe a novel technique for skull reduction cranioplasty with modified bilateral Pi craniectomy.
Cranioplasty in children is a controversial and challenging issue, since there is still no consensus on the ideal material. Main problems in paediatric age are represented by the child's growing skull, the lower bone thickness and the high incidence of cerebrospinal fluid (CSF) disorders or brain swelling. Autologous bone is still considered the "gold standard". When it is not available, a wide range of alloplastic materials have been proposed. Hydroxyapatite, a ceramic-based derivative, bears a chemical co...
Management of pediatric skull defects after decompressive craniectomy (DC) poses unique problems, particularly in children younger than 24-months. This includes complications including resorption and infection as well as difficulties with plagiocephaly and reconstruction. The goal of this study is to evaluate bone resorption complications after cranioplasty in patients
In open brain surgery, fixation of the bone flap is the final procedure. The bone flaps then fuse naturally. The objective of this study was to investigate the chronological process of bone fusion after craniotomy and autologous cranioplasty.
The use of autologous bone for cranioplasty offers superior cosmesis and cost-effectiveness compared to synthetic materials. The choice between two common autograft storage mechanisms - subcutaneous versus frozen - remains controversial and dictated by surgeon preference.
Decompressive craniectomy (DC) is an established neurosurgical emergency technique. Patient selection, optimal timing, and technical aspects related to DC and subsequent cranioplasty remain subjects of debate. For children, the overall degree of evidence is low, compared with randomized controlled trials (RCTs) in adults.
Cranioplasty (CP) is a multifaceted procedure in a heterogenous patient population, with a high risk for complication. However, no previous large-scale studies have compared outcomes in primary (ie, first attempt) CP versus revision CP (ie, following previous attempts). The authors, therefore, analyzed long-term outcomes of 506 consecutive primary and revision CPs, performed by a single surgeon.
To evaluate the role of lipotransfer in progressive scalp thinning following titanium mesh cranioplasty.
Cranioplasty is a common procedure in neurosurgery. However, cosmetic and neuroprotective reconstructions are necessary following cranioplasty. Treatment of patients with a meningioma with bone infiltration requires the removal of the tumor-infiltrated bone and subsequent cranioplasty. We report an efficient technique for cosmetic and neuroprotective reconstructions using a custom-made ultra-high-molecular-weight polyethylene cranial plate (SKULPIO®, Kyocera Medical, Kyoto, Japan) in a single-step surgery ...
Recurrent subdural hematoma (SDH) is commonly encountered in clinical practice. Multiple surgical techniques have been reported for the management of recurrent SDH with variable success and complication rates. We report an alternative technique to halt SDH re-accumulation in elderly patients with multiple recurrences despite multiple surgical evacuations via rescue craniectomy and subsequent cranioplasty.
After a decompressive craniectomy (DC), a cranioplasty (CP) is often performed in order to improve neurosurgical outcome and cerebral blood circulation. But even though the performance of a CP subsequent to a DC has become routine medical practice, patients can in fact develop many complications from the surgery that could prolong hospitalization and lead to unfavorable prognoses. This study investigates one of the most frequent complications, bone flap infection, in order to identify prognostic factors of ...
: Cranioplasty (CP) is associated with high complication rates and patient-matched implants (PMI) are frequently used for CP. However, only limited data are available regarding complication rates of PMI-based CP after complex or failed primary CP. Here we report our experience with the use of polymethylmethacrylate (PMMA) PMI for this purpose. : We analyzed all patients with complex or failed primary CP and subsequent implantation of PMMA-PMI between 2010 and 2015 at our institution. : A total of 67 patient...
Current methods of transcranial diagnostic ultrasound imaging are limited by the skull's acoustic properties. Craniotomy, craniectomy, and cranioplasty procedures present opportunities to circumvent these limitations by substituting autologous bone with synthetic cranial implants composed of sonolucent biomaterials.
Cerebellar slump is a rarely reported complication of craniocervical decompression for Chiari malformation. This is known to occur following an oversized bony decompression of the cranio-vertebral junction. The index case is the first reported which developed this phenomenon following cerebellar hemispheric haematoma removal. Disturbance of CSF circulation in the presence of a calvarial defect may have been the cause. The patient was treated with a titanium mesh cranioplasty of the posterior cranial defect,...
The purpose of this study was to compare surgical site infection (SSI) rates between resorbable plates and titanium plates used for adult patients with intractable epilepsy who underwent epilepsy surgery following subdural electrode placement.
Cranioplasty is essential because cranial defects cause cosmetic and functional problems, and neurologic sequalae in patients. However, reconstruction options are limited in patients with unfavorable conditions. This study aimed to review our experience with skull defect reconstruction using autogenous bone with sagittal split rib bone grafts or latissimus dorsi rib myoosseocutaneous free flaps.
Autologous bone graft reimplantation remains the standard treatment after decompressive hemicraniectomy. Unfortunately, some patients present with signs of bone resorption without any visible signs of infection; the reasons remain unknown. Contamination with Propionibacterium acnes has been discussed as a potential source of the osteolytic process. The aim of this study was to investigate the microbial spectrum detected in samples of grafts from patients with aseptic bone resorption and compare them to sept...
A 52-year-old African American female suffered a spontaneous right middle cerebral artery (MCA) aneurysm rupture treated with emergent right craniectomy and MCA artery clipping. She was admitted to inpatient rehabilitation (IPR) 6 weeks after her initial injury and was requiring maximum to total assistance for functional tasks. She made significant functional gains during the first 17 days of IPR admission, she developed headaches, new cognitive deficits, and increased difficulty with standing and eating. H...