A randomised controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty: long-term follow-up

Honeybul, Stephen; Morrison, David A.; Ho, Kwok M.; Lind, Christopher R. P.; Geelhoed, Elizabeth

doi:10.1007/s00701-018-3514-z

Cited by 54 publications

(45 citation statements)

References 15 publications

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“…We are also aware that combination of patients aged under 18 and over 65 years into one cohort to achieve an adequate group size might have precluded the detection of outcome differences between both populations. For more accurate results regarding the longterm outcome of secondary CP large, prospectively designed clinical trials would be required, such as the recently published study by Honeybul et al comparing titanium with ACB implants [25]. Finally, we used a modified classification to quantify bone graft resorption-adapted to the high prevalence of advanced cases in our cohort-limiting comparability to previous studies.…”

Section: Limitationsmentioning

confidence: 99%

The impact of implant material and patient age on the long-term outcome of secondary cranioplasty following decompressive craniectomy for severe traumatic brain injury

et al. 2020

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Background Secondary cranioplasty (CP) is considered to support the neurological recovery of patients after decompressive craniectomy (DC), but the treatment success might be limited by complications associated to confounders, which are not yet fully characterized. The aim of this study was to identify the most relevant factors based on the necessity to perform revision surgeries. Methods Data from 156 patients who received secondary CP following DC for severe traumatic brain injury (TBI) between 1984 and 2015 have been retrospectively analyzed and arranged into cohorts according to the occurrence of complications requiring surgical intervention. Results Cox regression analysis revealed a lower revision rate in patients with polymethylmethacrylate (PMMA) implants than in patients with autologous calvarial bone (ACB) implants (HR 0.2, 95% CI 0.1 to 1.0, p = 0.04). A similar effect could be observed in the population of patients aged between 18 and 65 years, who had a lower risk to suffer complications requiring surgical treatment than individuals aged under 18 or over 65 years (HR 0.4, 95% CI 0.2 to 0.9, p = 0.02). Revision rates were not influenced by the gender (p = 0.88), timing of the CP (p = 0.53), the severity of the TBI (p = 0.86), or the size of the cranial defect (p = 0.16).Conclusions In this study, the implant material and patient age were identified as the most relevant parameters independently predicting the long-term outcome of secondary CP. The use of PMMA was associated with lower revision rates than ACB and might provide a therapeutic benefit for selected patients with traumatic cranial defects.

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Section: Limitationsmentioning

confidence: 99%

The impact of implant material and patient age on the long-term outcome of secondary cranioplasty following decompressive craniectomy for severe traumatic brain injury

et al. 2020

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“…Overview Despite a long-lasting debate, no agreement has been reported in the literature regarding what is the best cranioplasty material [86]. The majority of debates in literature concern the optimal CP material and revolve around the choice between autologous bone and other biomaterials, either biologic or synthetic ones [31]. This area is wide open to further development and refinement when it comes to CP procedures.…”

Section: Consensus Topic 2: Materialsmentioning

confidence: 99%

“…Hardness and stability are the main advantages of this material [33]. Titanium plates constitute the most common solution, with better cosmetic and functional outcomes, compared to autologous bone without increasing overall health care costs as reported in a recent randomized controlled trial [31]. However, non-physiological heat conduction, radiopacity with significant artefact, and difficulty intra-operatively shaping are the main disadvantages.…”

Section: Titaniummentioning

confidence: 99%

“…In the literature, the definition of "early CP" is ill-defined and has been reported at various time intervals varying from less than 4 weeks up to 12 weeks. Because of this lack of consistency in the literature, the impact of timing on functional outcome is not well defined from literature data [22,31,47,86]. However, a recent comprehensive systematic review concluded that CP may "improve neurological function, and earlier cranioplasty may enhance this effect" [63].…”

Section: Consensus Topic 3: Timingmentioning

confidence: 99%

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Consensus statement from the international consensus meeting on post-traumatic cranioplasty

et al. 2020

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Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

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“…[ 13 ] Revision surgery with replacement of synthetic material is necessary in severe cases of BFR and second surgery could be associated with higher expenses and poor clinical outcomes. [ 14 , 15 ] It would be reasonable to identify high-risk group that might suffer BFR and take preventive measures or choose alloplastic material cranioplasty for those patients.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for bone flap resorption after autologous bone cranioplasty

Yang

Yuan

et al. 2020

Medicine

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Background: One of the most common complications following autologous cranioplasty is bone flap resorption (BFR). Severe BFR can lead to revision surgery with implantation of synthetic bone flap and also necessarily lead to higher hospital expenses. This study aims to perform a meta-analysis to summarize available evidence regarding risk factors of BFR requiring a second surgery in patients with autologous cranioplasty. Methods: Cohort, case-control, and cross-sectional studies that report the incidence and risk factors of BFR among patients with autologous cranioplasty, published in English, will be considered for selection. Three databases from inception to May 2020 will be searched. The process of data selection, quality assessment, and data extraction will be assessed by 2 authors independently. The study quality will be assessed by Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality checklist. The statistical analysis of this meta-analysis will be calculated by Review manager version 5.3. Results: The results of this systematic review and meta-analysis will be disseminated through academic conferences and expected to publish in a peer-reviewed journal Conclusion: This study will offer high-quality evidence about risk factors for BFR after autologous cranioplasty. Registration number: INPLASY202050063.

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A randomised controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty: long-term follow-up

Abstract: Bone resorption continued to occur beyond 12 months after autologous cranioplasty; use of primary titanium cranioplasty after decompressive craniectomy reduced the number of reoperations needed and the associated long-term total hospital costs.

Cited by 54 publications

References 15 publications

The impact of implant material and patient age on the long-term outcome of secondary cranioplasty following decompressive craniectomy for severe traumatic brain injury

The impact of implant material and patient age on the long-term outcome of secondary cranioplasty following decompressive craniectomy for severe traumatic brain injury

Consensus statement from the international consensus meeting on post-traumatic cranioplasty

Risk factors for bone flap resorption after autologous bone cranioplasty

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