Reconstruction of Cranial Defects with Individually Formed Cranial Prostheses Made of Polypropylene Polyester Knitwear: An Analysis of 48 Consecutive Patients

Kasprzak, Piotr; Tomaszewski, Grzegorz; Kotwica, Z; Kwinta, Borys; Zwoliński, Jerzy

doi:10.1089/neu.2011.2247

Cited by 11 publications

(4 citation statements)

References 15 publications

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“…There were no cases of infection reported in previously published series [ 13 , 28 ], but a proportion of craniotomies for tumours will unfortunately develop infection requiring craniotomy flap explantation, whether this was a primary untreated bone (2% [ 21 ]), autoclaved bone (up to 4% [ 24 ]), bone autologous graft (up to 5% [ 9 ]), or an allograft (Table 2 , up to 17% [ 17 ]). Table 2 summarises studies of cranioplasty for bone-invasive meningioma [ 3 , 6 , 12 , 15 , 17 , 19 , 22 ]. One of our cases underwent removal of the titanium mesh in the absence of infection (Case 3).…”

Section: Discussionmentioning

confidence: 99%

Intra-operative extracorporeal irradiation of tumour-invaded craniotomy bone flap in meningioma: a case series

Cook,

Burton,

Jefferies

et al. 2024

Acta Neurochir

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Background Extracorporeal irradiation of tumorous calvaria (EITC) can be performed to restore function and form of the skull after resection of bone-invasive meningioma. We sought to examine the rate of tumour recurrence and other selected outcomes in patients undergoing meningioma resection and EITC. Methods Retrospective single-centre study of adult patients undergoing meningioma resection and EITC between January 2015 and November 2022 at a tertiary neurosurgical centre. Patient demographics, surgery data, tumour data, use of adjuvant therapy, surgical complications, and tumour recurrences were collected. Results Eighteen patients with 11 (61%) CNS WHO grade 1, 6 (33%) grade 2, and 1 (6%) grade 3 meningiomas were included. Median follow-up was 42 months (range 3–88). Five (28%) patients had a recurrence, but none were associated with the bone flap. Two (11%) wound infections requiring explant surgery occurred. Six (33%) patients required a further operation. Two operations were for recurrences, one was for infection, one was a washout and wound exploration but no evidence of infection was found, one patient requested the removal of a small titanium implant, and one patient required a ventriculoperitoneal shunt for a persistent CSF collection. There were no cases of bone flap resorption and cosmetic outcome was not routinely recorded. Conclusion EITC is feasible and fast to perform with good outcomes and cost-effectiveness compared to other reconstructive methods. We observed similar recurrence rates and lower infection rates requiring explant compared to the largest series of cranioplasty in meningioma. Cosmetic outcome is universally under-reported and should be reported in future studies.

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Section: Discussionmentioning

confidence: 99%

Intra-operative extracorporeal irradiation of tumour-invaded craniotomy bone flap in meningioma: a case series

Cook,

Burton,

Jefferies

et al. 2024

Acta Neurochir

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“…is result was predictable given the technical difficulties of adequately reproducing the normal shape and cranial conformation; the data were widely discussed in the literature, in which many authors showed the superiority of the cosmetic result of custom-made prostheses, both in titanium [3,13,21] and in other biomaterials such as HA, PMMA, and PEEK. [8,9,[14][15][16]25] An adequate aesthetic result is of great importance both for the psychological perspective of the patient and their relatives and because, in some cases, a prostheses with inadequate curvature can promote pain in the temporal region or skin decubitus which, in turn, can cause the prostheses to fail. It is for these reasons that the cosmetic result is considered one of the main outcomes of cranioplasty.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two different titanium cranioplasty methods: Custom-made titanium prostheses versus precurved titanium mesh

Policicchio

Casu

Dipellegrini

et al. 2020

Surgical Neurology International

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Background: The aim of this study was to compare the results of two different titanium cranioplasties for reconstructing skull defects: standard precurved mesh versus custom-made prostheses. Methods: Retrospective analysis of 23 patients submitted to titanium cranioplasty between January 2014 and January 2019. Ten patients underwent delayed cranioplasty using custom-made prostheses; and 13 patients were treated using precurved titanium mesh (ten delayed cranioplasties, and three single-stage resection- reconstructions). Demographic, clinical, and radiological data were recorded. Results and complications of the two methods were compared, including duration of surgery, cosmetic results (visual analog scale for cosmesis [VASC]), and costs of the implants. Results: Complications: one epidural hematoma in the custom-made group, one delayed failure in precurved group due to wound dehiscence with mesh exposure. There were no infections in either group. All custom-made prostheses perfectly fitted on the defect; eight of 13 precurved mesh prostheses incompletely covered the defect. Custom-made cranioplasty obtained better cosmetic results (average VASC 94 vs. 68), shorter surgical time (141min vs. 186min), and -fewer screws was needed to fix the prostheses in place (6 vs. 15). However, satisfactory results were obtained using precurved mesh in cases of small defects and in single-stage reconstruction. Precurved mesh was found to be cheaper (€1,500 vs. €5,500). Conclusion: Custom-made cranioplasty obtained better results and we would suggest that this should be a first choice, particularly for young patients with a large cranial defect. Precurved mesh was cheaper and useful for single-stage resection-reconstruction. Depending on the individual conditions, both prostheses have their place in cranioplasty therapies.

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“…Several other polymers have been investigated for large format cranial implants: PEEK (poly-ether-ether ketone), 36 Polypropylene Polyester Knitwear, 37 and PEKK (Poly-ether-ketone ketone) (Figure 4). 38 There is also an FDA-approved PEKK custom cranial implant product (Oxford Performance Materials, South Windsor, CT).…”

Section: Advances In Alloplastic Bone Substitutes For Cranial Repairmentioning

confidence: 99%

The Recent Revolution in the Design and Manufacture of Cranial Implants

et al. 2015

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Large format (i.e., > 25 cm2) cranioplasty is a challenging procedure not only from a cosmesis standpoint, but also in terms of ensuring that the patient's brain will be well-protected from direct trauma. Until recently, when a patient's own cranial flap was unavailable, these goals were unattainable. Recent advances in implant Computer Aided Design and 3-D printing are leveraging other advances in regenerative medicine. It is now possible to 3-D-print patient-specific implants from a variety of polymer, ceramic, or metal components. A skull template may be used to design the external shape of an implant that will become well integrated in the skull, while also providing beneficial distribution of mechanical force distribution in the event of trauma. Furthermore, an internal pore geometry can be utilized to facilitate the seeding of banked allograft cells. Implants may be cultured in a bioreactor along with recombinant growth factors to produce implants coated with bone progenitor cells and extracellular matrix that appear to the body as a graft, albeit a tissue-engineered graft. The growth factors would be left behind in the bioreactor and the graft would resorb as new host bone invades the space and is remodeled into strong bone. As we describe in this review, such advancements will lead to optimal replacement of cranial defects that are both patient-specific and regenerative.

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Reconstruction of Cranial Defects with Individually Formed Cranial Prostheses Made of Polypropylene Polyester Knitwear: An Analysis of 48 Consecutive Patients

Cited by 11 publications

References 15 publications

Intra-operative extracorporeal irradiation of tumour-invaded craniotomy bone flap in meningioma: a case series

Intra-operative extracorporeal irradiation of tumour-invaded craniotomy bone flap in meningioma: a case series

Comparison of two different titanium cranioplasty methods: Custom-made titanium prostheses versus precurved titanium mesh

The Recent Revolution in the Design and Manufacture of Cranial Implants

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