Methyl methacrylate cranioplasty

Abstract

The use of methyl methacrylate for cranioplastic repair in 417 patients over a 13 year period has been presented. Its advantages have been noted as well as the indications and the operative technique. Infection has occurred in less than one percent, and half of these cases (2) were due to surgical errors.Operations for repair of cranial defects have been performed for many years, and a good historical account is given by Reeves 3. Many different materials have been used which have included bone (autogenous, homogenous, and heterogenous), metal (aluminum, gold, silver, lead, vitallium, ticonium, tantalum, and stainless steel), and alloplasties (celluloid and acrylic resins). The use of many of these substances has been discontinued, but acrylic resin, tantalum and bone are ones that have remained popular and are in current use by neurosurgeons and plastic surgeons.Bone and tantalum eranioplasties were being performed by the Neurosurgical Service at Walter Reed General Hospital until 1957 when the acrylic resin, methyl methaerylate, was evaluated. Methyl methaerylate is known by various trade names as lucite, vitaerylic, plexiglass or crystallite.Since our preliminary evaluation with methyl methacrylate, we have continued to use it as the material of choice, to the virtual exclusion of all others. 4t7 patients have had insertion of methyl methacrylate prostheses from 1957 through 1969. 70 W, M. Hammon and L. G. Kempe: Pre-operative Evaluation and Operative ProcedurePrior to surgery, complete x-ray examination of the skull is performed, and where the defect includes an air sinus region, special attempts are made to try and determine the presence of any air in the sinus which would preclude the performance of the eranioplasty, but indicate the need for a further exenterative procedure. Evidence of osteomyelitis is a eontraindieation to eranioplasty.

Comparison of Complications Following Cranioplasty Using a Sterilized Autologous Bone Flap or Polymethyl Methacrylate

“…Previous studies reported that a longer time interval between DC and CP increased the risk of SSI 12). Recently, however, Sundseth et al30) found no statistically significant relationship between the time interval from DC to CP and the risk for SSI.…”

Custom Made Acrylic Tracheal Stent for Tracheal Stenosis

“…They have proven biocompatibility when they are in contact with vital tissues [6]. In present article heat polymerized acrylic stent was used instead of silicone T tube for replacement of stenosed tracheal segment.…”

Successful Use of Rib Grafts for Cranioplasty in Children

“…Low morbidity and mortality are expected [1, 2, 3, 21, 23]. It is inexpensive, easily molded at the time of operation and associated with a short operative time.…”

“…The complication rate of methylmethacrylate cranioplasty specifically within the pediatric population has been quoted as high as 23% [6]. Further considerations in pediatric patients include durability of both the graft and the overlying skin which may be thin or atrophic [1, 3]. Autogenic bone is better suited for grafting into the immature skull, as it can provide protection and aesthetic function while also allowing for continued growth.…”

“…Perhaps the most widely used material for cranioplasty is polymethylmethacrylate (PMMA) [1, 2]. Particularly with the developing skull, use of plastics and metals are disadvantageous as they are biologically inert and fail to keep up with the dynamic contouring of the cranium.…”