Health-related quality of life following cranioplasty – a systematic review

Mustafa, Mohammad; Richardson, George E.; Gillespie, Conor S; Clynch, Abigail L; Keshwara, Sumirat M; Gupta, Shubhi; George, Alan M; Islim, Abdurrahman I; Brodbelt, Andrew; Duncan, Christian A.; McMahon, Catherine; Sinha, Ajay; Jenkinson, Michael D.; Millward, Christopher P

doi:10.1080/02688697.2023.2202244

Cited by 3 publications

(3 citation statements)

References 39 publications

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“…In fact, our results compare very favorably with the previously published literature, documenting SSI rates as high as 12% 6,10,17,18 (3.4% in this series) and surgical morbidity up to 30%. [8][9][10][11][12][13] The tenets of our technique were adopted and/or developed to facilitate myocutaneous flap dissection and temporalis muscle management, minimize intraoperative complications, reduce postoperative infection, optimize cosmetic and masticatory outcomes, and maximize surgical efficiency. Hemostasis during surgery is deliberately minimized to preserve bleeding healthy tissues surrounding the implant and skin edges.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…6,7 Thus, the overall morbidity associated with cranioplasty, including wound dehiscence, poor cosmesis, and masticatory dysfunction, has been estimated to range from 8% to 30%. [8][9][10][11][12][13] Despite a growing body of literature, 1,2 few publications focus on the operative technique, especially technical nuances of temporalis management. [14][15][16][17][18] Since 2019, the senior author has developed and consistently used a two-stage dissection technique, allowing us to elevate the myocutaneous flap methodically and safely during cranioplasty-believed to facilitate atraumatic muscle dissection, maximize cosmetic outcomes, and minimize morbidity.…”

mentioning

confidence: 99%

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Two-Stage Anatomic Myocutaneous Flap Dissection in Cranioplasty: Technical Nuances and Single-Surgeon Experience

Sorek,

Miller,

Griepp

et al. 2024

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Temporalis muscle management remains one of the most challenging aspects of cranioplasty, which accounts for considerable rates of dissection-related complications. Since 2019, the senior author has developed and consistently used a methodical, two-stage anatomic dissection technique to separate the scalp and temporalis muscle from the underlying brain. This technique is believed to facilitate dissection and minimize the risk of brain injury, while optimizing cosmetic outcomes. METHODS: All patients who underwent cranioplasty between January 2019 and February 2023 were identified from a prospectively maintained database. Charts were retrospectively reviewed. Demographic, clinical, and procedural data were extracted and analyzed. RESULTS: Twenty-nine patients, 20 men and 9 women with a median age of 37 years (range 17-72), were identified. Indications for craniectomy were traumatic brain injury in 18 (62.1%), hemorrhagic stroke in five (17.2%), ischemic stroke in four (13.8%), and aneurysmal subarachnoid hemorrhage in two (6.9%). Median precranioplasty modified Rankin Scale and Glasgow Coma Scale scores were 5 (range in series: 0-5) and 14 (range in series: 3-15), respectively. The median time to cranioplasty was 131 days (32-1717). Cranioplasty was technically successful in all patients, with a median operative time of 106 minutes (62-182). There were no intraoperative complications. Postoperative complications occurred in three patients (10.3%): hemorrhagic brain contusion (n = 1), meningitis (n = 1), and seizure (n = 1). Of those, one patient (3.4%) died 2 weeks after surgery from suspected pulmonary embolism. After a median follow-up of 4 months (1-44), all 28 survivors have either remained clinically stable or exhibited neurological improvement. Cosmetic results were good or excellent in 27 (96.4%) and fair in one (3.6%). CONCLUSION: Two-stage anatomic dissection of the scalp and temporalis muscle during cranioplasty can maximize surgical efficiency and result in excellent outcomes. Cranioplasty should be considered a low-risk, low-complexity neurosurgical procedure. Safe and efficient management of the temporalis muscle is key.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Two-Stage Anatomic Myocutaneous Flap Dissection in Cranioplasty: Technical Nuances and Single-Surgeon Experience

Sorek,

Miller,

Griepp

et al. 2024

Operative Neurosurgery

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Daily life without cranial bone protection while awaiting cranioplasty: a qualitative study

Gustavsson,

Jangland,

Nyholm

2024

Acta Neurochir

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Purpose Decompressive craniectomy is occasionally performed as a life-saving neurosurgical intervention in patients with acute severe brain injury to reduce refractory intracranial hypertension. Subsequently, cranioplasty (CP) is performed to repair the skull defect. In the meantime, patients are living without cranial bone protection, and little is known about their daily life. This study accordingly explored daily life among patients living without cranial bone protection after decompressive craniectomy while awaiting CP. Methods A multiple-case study examined six purposively sampled patients, patients’ family members, and healthcare staff. The participants were interviewed and the data were analyzed using qualitative content analysis. Results The cross-case analysis identified five categories: “Adapting to new ways of living,” “Constant awareness of the absence of cranial bone protection,” “Managing daily life requires available staff with adequate qualifications,” “Impact of daily life depends on the degree of recovery,” and “Daily life stuck in limbo while awaiting cranioplasty.” The patients living without cranial bone protection coped with daily life by developing new habits and routines, but the absence of cranial bone protection also entailed inconveniences and limitations, particularly among the patients with greater independence in their everyday living. Time spent awaiting CP was experienced as being in limbo, and uncertainty regarding planning was perceived as frustrating. Conclusion The results indicate a vulnerable group of patients with brain damage and communication impairments struggling to find new routines during a waiting period experienced as being in limbo. Making this period safe and reducing some problems in daily life for those living without cranial bone protection calls for a person-centered approach to care involving providing contact information for the correct healthcare institution and individually planned scheduling for CP.

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A comprehensive analysis of high-temperature material extrusion 3D printing parameters on fracture patterns and strength of polyetheretherketone cranial implants

Sonaye,

Mack,

Tan

et al. 2024

Prog Addit Manuf

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A polyetheretherketone (PEEK) cranial implant is one of the most well-known polymeric implants used in cranioplasty. However, most off-the-shelf PEEK cranial implants are developed by molding and then sized into the patient's defect anatomy by machining, which is time-consuming and capital-intensive. On the contrary, 3D printing, specifically material extrusion, can develop patient-specific cranial implants that precisely fit the defect anatomy, ensuring stable fixation and restoring esthetic cranial symmetry. However, 3D printing high-quality, mechanically robust PEEK implants are challenging due to the high thermal processing conditions required for PEEK printing, its high melt viscosity, and its susceptibility to incomplete crystallization. If appropriately attuned, an optimized set of 3D printing conditions can yield high-quality patient-specific PEEK cranial implants with clinically relevant mechanical properties. Hence, in this study, we comprehensively analyzed the effect of essential 3D printing conditions on cranial implants' material and mechanical properties. Specifically, we varied critical 3D printing material extrusion parameters, such as build orientation, nozzle, bedplate, chamber temperature, and print speed, and analyzed their effect on the implants' impact strength. We also used microscopy and Finite Element Analysis to understand the implants' fracture patterns with the impact indentor's impact. Based on our research, we determined an optimized set of 3D printing conditions to yield cranial implants with appropriate impact strength. Our results revealed that specimens printed at 0° build orientation, i.e., parallel to the bedplate, with optimum printing parameters, such as nozzle, bedplate, chamber temperature, and print speed, sustained a peak force of 2034 N. We envision that this study will help implant manufacturers utilize high-temperature material extrusion 3D printing to develop patient-specific PEEK cranial implants with clinically viable mechanical properties.

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Health-related quality of life following cranioplasty – a systematic review

Cited by 3 publications

References 39 publications

Two-Stage Anatomic Myocutaneous Flap Dissection in Cranioplasty: Technical Nuances and Single-Surgeon Experience

Two-Stage Anatomic Myocutaneous Flap Dissection in Cranioplasty: Technical Nuances and Single-Surgeon Experience

Daily life without cranial bone protection while awaiting cranioplasty: a qualitative study

A comprehensive analysis of high-temperature material extrusion 3D printing parameters on fracture patterns and strength of polyetheretherketone cranial implants

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