Reconstructive surgery of the skullcap through pmma custom prosthesis after decompressive craniectomies.

Abstract

INTRODUCTION: Decompressive craniectomy is indicated for the treatment of intracranial hypertension in cases of serious traumatic brain injury. This surgery results in a bizarre appearance, as if "part of the head" had been. After regression of cerebral edema and when the patient is in good clinical condition, the reconstruction of the skull is indicated. Reconstruction of the skull can be performed with autologous bone or with alloplastic materials. This study sought to present the experience of the author with skull reconstructions using custom PMMA prostheses.
 METHODS: In between 2014 and 2015, fourteen patients with previous (longer than 6 months) decompressive craniectomies were selected after Neurosurgery medical clearance and underwent skull reconstruction with customized PMMA prototyped prostheses. Signs and symptoms of syndrome of the trephined, computed tomography, and aesthetic appearance of the patients were analyzed preoperatively and at 6 months after reconstruction.
 RESULTS: All patients presented with improved symptomatology, aesthetic improvement and expansion of the brain after surgery.
 CONCLUSION: Reconstruction of the skull with customized prototyped PMMA prostheses improved the signs and symptoms and the aesthetic appearance in all 14 patients of this series. The use of prototypes to customize cranial prostheses facilitates the operative technique and enables patients to develop a nearly normal cranial contour.

Syndrome of trephined: Rehabilitation with PMMA alloplastic implant prosthesis-Case series

“…PMMA has been used since 1940 by Zander to repair craniofacial defects and has the advantage of being molded preoperatively into the shape of the cranial defect and it is economical. 5 The recent concept of digitization in the fabrication of the cranial implant prosthesis has yielded precisely fitting and accurate prostheses. The cone beam computed tomography can be utilised effectively for this.…”

Ventriculoperitoneal shunt occlusion and cranioplasty

“…The restoration of the anatomic barrier between intracranial structures and the environment normalize the dynamics of CSF and the blood flow inside the brain. 1,4,5 Even though the ideal moment for performing cranioplasty remains uncertain, recent studies show that it should be done between 3 to 6 months later, in order to allow for significant motor skill and cognitive recovery. 4,12 Cranioplasty after DC for management of elevated intracranial pressure is a neurosurgical procedure that seeks to restore stasis, improve the dynamic of CSF and establish the conditions for protecting the brain.…”

“…In this context, patients submitted to DC may need cranioplasty and VPS after the subacute stage. 1,8,12 Diagnostic of hydrocephalus in people who have had hemicraniectomy surgical procedures done is necessarily subjective, since criteria based on measuring intracranial pressure or details on ventricular structure are generally not reliable in the scenario of an open cranial vault. However, the almost universal disposition towards the progressive accumulation of CSF in these individuals, frequently manifested as an increase in extra-axial gatherings over the hemispheric convexity, indicates an incapacity for adequately balancing the production of CSF by draining the venous sinuses.…”

“…Decompressive craniectomy (DC) is efficient in reducing intracranial pressure (ICP) in patients with intracranial hypertension in complications of brain infarction that do not respond to clinical treatment, traumatic brain injury (TBI), intracerebral hemorrhage and aneurysmal intracerebral hemorrhage. 1,4 Hydrocephalus is present in 2 to 29% of those who undergo craniectomy, possibly requiring ventriculoperitoneal shunt (VPS) after the subacute stage. Most of the patients needing craniectomy accompanied by VPS develop sinking skin flap syndrome.…”