Traumatic brain injury (TBI) is a leading cause of death and disability for which there is currently no effective drug therapy available. Because drugs targeting a single TBI pathological pathway have failed to show clinical efficacy to date, pleiotropic agents with effects on multiple mechanisms of secondary brain damage could represent an effective option to improve brain recovery and clinical outcome in TBI patients. In this multicenter retrospective study, we investigated severity-related efficacy and safety of the add-on therapy with two concentrations (20 ml/day or 30 ml/day) of Cerebrolysin (EVER Neuro Pharma, Austria) in TBI patients. Adjunctive treatment with Cerrebrolysin started within 48 hours after TBI and clinical outcomes were ranked according to the Glasgow Outcome Scale and the Modified Rankin Disability Score at 10 and 30 days post-TBI. Analyses of efficacy were performed separately for subgroups of patients with mild, moderate or severe TBI according to Glasgow Coma Scale scores at admission. Compared to standard medical care alone (control group), both doses of Cerebrolysin were associated with improved clinical outcome scores at 10 days post-TBI in mild patients and at 10 and 30 days in moderate and severe cases. A dose-dependent effect of Cerebrolysin on TBI recovery was supported by the dose-related differences and the significant correlations with treatment duration observed for outcome measures. The safety and tolerability of Cerebrolysin in TBI patients was very good. In conclusion, the results of this large retrospective study revealed that early Cerebrolysin treatment is safe and is associated to improved TBI outcome.

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Cranioplasty represent surgical repairs of defects or deformities of the skull which may come as a result of trauma or congenital malformations. The notable advance in cranioplasties came with the experimental groundwork in bone grafting, performed in the late 19th century, based on which, the use of autografts for cranioplasty became popular in the early 20th century. With the First and Second World Wars alternative metals and plastics were needed to cover large cranial defects suffered in combat as precious metals became scarce. As time passed metallic bone substitutes have gradually become obsolete and modern non-immunogenic plastics such as Polymethylmethacrylate (PMMA) snf Polyetheretherketone (PEEK) replaced them, the major downside of the technique being represented by the high costs. The authors present a statistic of 25 patients treated over a period of 4 years in 3 major neurosurgical units – which beneffited from the neurosurgical use of biomaterials for the repair of major cranial defects following congenital malformations, post-surgical cranial defects or trauma of the skull. We excluded large bone flaps for decompressive craniotomy. The authors used PMMA (Polymethylmethacrylate) and PEEK-based implants. There were 12 cases in which PMMA was used and 13 cases in which PEEK-based implants were used. The authors present a personal comparrison between the two materials. At the same time, the authors perform a comprehensive review of how the techniques have evolved from simple metal to modern biopolymers and how the modern technology will impact the future of cranial reconstruction