Management of cranial and craniofacial bone defects with prefabricated individual titanium implants: follow-up and evaluation of 166 patients with 169 titanium implants from 1994 to 2000

Eufinger, H.; Weihe, S.; Scherer, Philipp; Rasche, Christian; Wehmöller, M.

doi:10.1007/s11548-006-0054-4

Cited by 13 publications

(10 citation statements)

References 23 publications

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“…In a large Australian study with long-term follow-up, not a single patient noted a poor cosmetic result 52 ; multicenter experiences in Europe and the United States also report favorable results. 53 These encouraging outcomes, combined with mechanical strength, low infection rates, and biocompatibility make titanium an attractive option. 54 Titanium is sometimes described as a material of last resort in the adult population.…”

Section: Titaniummentioning

confidence: 99%

Cranioplasty for Large-Sized Calvarial Defects in the Pediatric Population: A Review

Lam

Kuether

Fong

et al. 2015

Craniomaxillofacial Trauma & Reconstruction

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Large-sized cranial defects can arise from many etiologies, including open skull trauma, infection, tumor, and craniofacial reconstruction complications. With advances in neurotrauma care and early surgical decompression, trauma outcomes have improved over time; survivors are left with cranial defects. While large retrospective studies and metaanalyses of adult cranioplasty have been conducted, less is known about outcomes in the pediatric population.Reimplantation of the autologous bone flaps in children is thought to be advantageous. The osseous material can become reincorporated over the process of a child's maturation and growth. However, bone resorption is seen in up to 50% in the pediatric population 1,2 compared with up to 6.5% in adults, 3 necessitating further reconstructive surgery either with further autologous materials (split-thickness cranial bone graft, particulate bone graft with or without resorbable mesh), or other alloplastic materials (methyl methacrylate, hydroxyapatite cement, demineralized bone, and titanium mesh). We review the literature on special considerations, materials, and outcomes of large-sized cranioplasty in children such as after decompressive craniectomy (►Table 1). Autologous ReconstructionAutologous cranioplasty after decompressive craniectomy is considered the gold standard in pediatric care because of the ability of the bone graft to reincorporate into the skull (osseointegration), lower risk of material rejection, and ability to allow growth of the skull. There are several approaches to this form of reconstruction (►Table 2). The three main ways to perform an autologous cranioplasty use bone stored in the body, cryopreserved bone, or bone flaps harvested from a donor site. With pediatric patients, additional considerations must account for the high incidence of bone resorption (►Fig. 1a-c), the immature osseous skeleton, and future growth. Bone Flap Storage MethodsMethods of bone preservation each have advantages and drawbacks. Cryopreservation of the bone flap obviates a second surgical site and is favored by most of the U.S. centers. However, cryopreservation requires facilities for bone storage; in cases of geographic transfer of patient care, logistics of transport pose additional difficulty.4 In addition, the freezing process can devitalize the bone and result in an increased rate of complications including infection, resorption, and cosmetic deformity. AbstractLarge-sized calvarial defects in pediatric patients pose a reconstructive challenge because of children's unique physiology, developing anatomy, and dynamic growth. We review the current literature and outcomes with autologous and alloplastic cranioplasty in the pediatric population.

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Section: Titaniummentioning

confidence: 99%

Cranioplasty for Large-Sized Calvarial Defects in the Pediatric Population: A Review

Lam

Kuether

Fong

et al. 2015

Craniomaxillofacial Trauma & Reconstruction

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“…In 2006, Eufinger et al showed a comparable reoperation rate of 21% and secondary implant removal rate in 8.4% for titanium. 6 The main reasons for explantation were wound dehiscence with infections in 5 of 6 cases and a single case of infected epidural hematoma. Hill et al and Mukherjee et al also reported comparable reoperation rates.…”

Section: Discussionmentioning

confidence: 99%

“…Both manufacturers produce implants on the basis of individual CT data sets and a virtual computer-aided design construction process. 6,24 A randomized multicenter study was favored in order to gain data from a higher number of patients in a shorter time period.…”

mentioning

confidence: 99%

Cranioplasty using custom-made hydroxyapatite versus titanium: a randomized clinical trial

Lindner

Schlothofer-Schumann

Kern

et al. 2017

JNS

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OBJECTIVE Cranioplasty is routinely performed in neurosurgery. One of its underestimated problems is the high postoperative complication rate of up to 40%. Due to the lack of good prospective studies and the small number of patients (5-20 each year) who receive alloplastic materials, decisions in favor or against a certain material are based on subjective empirical or economic reasons. The main goal of this study-the first prospective, randomized multicenter study in Germany-of custom-made titanium and hydroxyapatite (HA) implants was to compare local and systemic infections related to the implant within the first 6 months after implantation. Secondary objectives included comparing the reoperation rate, the complication rate, clinical and neurological outcomes, and health-related quality of life. METHODS The study included patient screening and randomization at 6 to 8 weeks before operation; pre-, intra-, and postoperative documentation until discharge; and postoperative follow-ups after 1 and 6 months. Approval for the study was obtained from the local ethics committee. RESULTS A total of 52 patients were included in the study. The rate of local implant-associated wound infection in the HA group was 2 of 26 (7.7%) patients and 5 of 24 (20.8%) patients in the titanium group (p = 0.407). Systemic inflammation within 6 months after operation affected none of the patients in the HA group and 4 of 24 (37.5%) patients in the titanium group (p = 0.107). In both groups, 7 patients required reoperation after the 6-month follow-up (26.9% of the HA group and 29.2% of the titanium group; not significant). Reoperation with an explantation was necessary in 3 patients in each group (11.5% of the HA group and 12.5% of the titanium group; not significant). The results demonstrated a significantly higher number of epidural hematomas in the HA group in comparison with none in the titanium group. Altogether, 46 adverse events were found in 27 patients (54%). An improvement in the neurological outcome after 6 months was experienced by 43% of the patients in the HA group and 26.3% of the patients in the titanium group (p = 0.709). CONCLUSIONS The study emphasizes that cranioplasty is a high-risk intervention. In comparison with titanium, HA shows benefits in terms of the infection rate and the neurological outcome, but at the same time has a higher postoperative risk for epidural hematoma. Depending on the individual conditions, both materials have their place in future cranioplasty therapies. Clinical trial registration no.: NCT00923793 ( clinicaltrials.gov ).

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“…However, as titanium does not biologically interact with natural bone, tissue regeneration and prosthesis integration are not possible. Moreover, in the case of using titanium plates, common consequences are sensitivity to temperature or foreign body sensation, and psychological problems for the patient having to accept the implant for the rest of his/her life (Eufinger et al, 2006). Some studies have shown postoperative complications after titanium cranioplasty.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent article, the authors (Eufinger et al, 2006) concluded that only a biodegradable biomaterial, capable of leading to new bone regeneration and complete defect healing can result in real improvement for the patients.…”

Section: Discussionmentioning

confidence: 99%

Custom made bioceramic implants in complex and large cranial reconstruction: A two-year follow-up

Staffa

Barbanera

Faiola

et al. 2012

Journal of Cranio-Maxillofacial Surgery

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Management of cranial and craniofacial bone defects with prefabricated individual titanium implants: follow-up and evaluation of 166 patients with 169 titanium implants from 1994 to 2000

Cited by 13 publications

References 23 publications

Cranioplasty for Large-Sized Calvarial Defects in the Pediatric Population: A Review

Cranioplasty for Large-Sized Calvarial Defects in the Pediatric Population: A Review

Cranioplasty using custom-made hydroxyapatite versus titanium: a randomized clinical trial

Custom made bioceramic implants in complex and large cranial reconstruction: A two-year follow-up

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