A Medical Insight on the of Biomaterials for Cranioplasty Surgery

Abstract

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

New Concept in Cranioplasty Based on Biomaterials Performance in Various Clinical Cases

“…The term cranioplasty engulfs a wider series of procedures which can be performed using different types of materials -biologic or not, human or not, from the same individual, from other individuals or even from other species. However, as science progressed and the risks of each material used were understood, modern neurosurgery has a tendency to use either material coming from the patient itself or completely sterile materials crafted from non-biologic material (such as metal or various polymers) achieving in this way a rate of success of 99% in all patients [1,2].…”

“…Today, there are four known types of grafts for cranioplasty: autogenic grafts (the same bone is reused such) such as bone from cranium, ribs, shinbones, shoulder blades, sternum or ilia, allogenic grafts (the graft originates from another human) such as cartilage, xenogenic grafts (grafts transplanted from animals ex: bovines, pigs, etc.) and alloplastic grafts (graft consisting of inorganic material) such as celluloid, Polymethylmethacrylate-PMMA, polyetheretherketone-PEEK, hydroxyapatite, polyethylene, silicone, ceramic and other derivatives; metallic implants such as Aluminium, Gold, Silver, Lead, Platinum, Titanium, Tantalum and their alloys [1,3].…”