Surgical preference regarding different materials for custom-made allograft cranioplasty in patients with calvarial defects: Results from an internal audit covering the last 20 years

Ganau, Mario; Cébula, H.; Fricia, Marco; Zaed, Ismail; Todeschi, Julien; Scibilia, Antonino; Gallinaro, Paolo; Coca, Andrés; Chaussemy, Dominique; Ollivier, Irène; Ligarotti, Gianfranco K.I.; Santin, Marie des Neiges; Proust, F.; Chibbaro, Salvatore

doi:10.1016/j.jocn.2020.01.087

Cited by 30 publications

(20 citation statements)

References 37 publications

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“…Also, causes of the initial pathology resemble the common ones in the literature ( 21 , 22 ): trauma (60%), tumors (10.8%), vascular (9.2%), malformations (9.2%), infections (3.1%), and others (7.7%). The overall complication rate (16.9%) is similar to what was reported by Klieverik ( 7 ).…”

Section: Discussionmentioning

confidence: 71%

A Multicentric European Clinical Study on Custom-Made Porous Hydroxyapatite Cranioplasty in a Pediatric Population

et al. 2022

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BackgroundCranioplasty (CP) is a surgical intervention aiming to re-establish the integrity of skull defects. Autologous bone and different heterologous materials are used for this purpose, with various reported related complications, especially in children.This study aims to evaluate the rate of complication in a multicentric cohort of pediatric patients treated by porous hydroxyapatite (PHA) CP implantation and to assess the reliability of post-marketing clinical data collected by a manufacturing company.MethodsThe authors proactively collected clinical data from 20 institutions in different European countries for patients under the age of 16 treated with a PHA implant. The data were obtained by conducting an on-site interview with physicians in charge of the patients (Post-Marketing Surveillance, PMS group). The endpoints were the incidence of adverse events and related implant removal. The clinical data were compared to the company-based register including all patients under the age of 16 who received the same implant from January 1, 2004 to December 31, 2020, and the collecting complications voluntarily reported by surgeons (Database, DB group).ResultsThe two groups were similar in terms of demographic characteristics and rate of complications. In the PMS group, a total of 11 (16.9%) complications were reported in the group of 65 patients that were proactively collected. Both fractures and infections were the most common complications with 4 cases each (6.2%). In the case of both infections and fractures, revision surgery was required for only one patient (1.5%). Three (4.5%) cases of displacements were reported, and in one (1.5%) case, a surgical revision was required, for a total of 3 (4.5%) cases requiring surgical revision. The average follow-up was 26.7 months.ConclusionsDifferent from a previous study on adult age, pediatric neurosurgeons are more prone to report even to the manufacturing company complications related to skull reconstruction in children. Therefore, these data can be compared with those of other clinical studies. The PHA CP in this series of 65 patients presents a complication rate collected on-site that is similar to other heterologous materials.

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Section: Discussionmentioning

confidence: 71%

A Multicentric European Clinical Study on Custom-Made Porous Hydroxyapatite Cranioplasty in a Pediatric Population

et al. 2022

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“…Most studies described the use of bone substitutes in implant dentistry for alveolar ridge augmentation and not for restoration or large maxillary oncological defects. Thus, the presented case could be better compared with other craniofacial reconstructive procedures, such as neurosurgical cranioplasty that provides several examples of grafting procedure using bone substitutes [ 22 ]. However, to the best of our knowledge, equine-derived bone grafts have not been documented in published literature and could be considered for further clinical trials, as it has demonstrated optimal outcomes even in orthopedics [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Wide Anterior Maxillary Reconstruction with Equine Bone Xenograft: A Case Report of 24-Month Follow-Up

Cicco

Colella

Tartaro

et al. 2020

Case Reports in Surgery

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Introduction. Orofacial reconstruction plays an important role in the treatment of patients affected by oral and maxillofacial cancers. Improvements in technologies and studies of biomaterials have widely expanded surgical possibilities to achieve good functional and aesthetic outcomes. By the way, xenografting procedures gained great consensus in the last decades, because of their documented reliability and efficacy. We present a case of anterior maxillary chondrosarcoma (CHS) that has undergone surgical ablation followed by reconstruction with an equine-derived bone xenograft. Case Presentation. A 68-year-old woman affected by CHS of the premaxilla underwent surgical ablation involving the four incisors followed by reconstruction using an equine-derived bone substitute. Bony reconstruction was planned to achieve implant and dental prosthetic rehabilitation at a second surgical time. Primary surgery was carried out without complications. Good integration of the graft was confirmed by radiological examination. At 12-month follow-up, the patient refused the implant placement and spontaneously adopted a mobile prosthesis. One year later, plates and screws were removed, because of the exposure of a titanium plate. The graft was finally rejected within 3 weeks. Discussion. Nonantigenic equine-derived biomaterials have shown reliability and a good safety profile. In the presented case, implant insertion should have been performed 12 months after the primary surgery. During the follow-up, until dental mobile prosthesis was applied, clinical and instrumental examinations demonstrated a good integration of the graft. We suppose that a chronic inflammation of the mucosa led to the exposure of the plate, perhaps due to pressure, minimal movements, or imperfect fitting of the mobile prosthesis. Removal of fixation means was performed to prevent grafting failure, without success. On the other hand, missing load could induce the graft to act just like a prosthesis, without a real process of integration. Safety and reliability of equine-derived bone xenografts cannot be currently confirmed if not followed by implant insertion and dental rehabilitation.

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“…Nowadays, a vast range of methods and materials significantly enlarge surgeons’ artillery. To cover the cranial defects, there is a choice of allografts, autografts, xenografts, or other bone substitutes [ 104 , 105 , 106 , 107 ]. Cranioplasty with the use of bone, derived from decompressive surgery from the same patient via allograft, is often associated with bone resorption, auto-immunologic reactions and a high infection risk [ 108 , 109 ], and is often not feasible due to skull fractures.…”

Section: Cranioplastymentioning

confidence: 99%

Low-Cost Cranioplasty—A Systematic Review of 3D Printing in Medicine

et al. 2022

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The high cost of biofabricated titanium mesh plates can make them out of reach for hospitals in low-income countries. To increase the availability of cranioplasty, the authors of this work investigated the production of polymer-based endoprostheses. Recently, cheap, popular desktop 3D printers have generated sufficient opportunities to provide patients with on-demand and on-site help. This study also examines the technologies of 3D printing, including SLM, SLS, FFF, DLP, and SLA. The authors focused their interest on the materials in fabrication, which include PLA, ABS, PET-G, PEEK, and PMMA. Three-dimensional printed prostheses are modeled using widely available CAD software with the help of patient-specific DICOM files. Even though the topic is insufficiently researched, it can be perceived as a relatively safe procedure with a minimal complication rate. There have also been some initial studies on the costs and legal regulations. Early case studies provide information on dozens of patients living with self-made prostheses and who are experiencing significant improvements in their quality of life. Budget 3D-printed endoprostheses are reliable and are reported to be significantly cheaper than the popular counterparts manufactured from polypropylene polyester.

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Surgical preference regarding different materials for custom-made allograft cranioplasty in patients with calvarial defects: Results from an internal audit covering the last 20 years

Cited by 30 publications

References 37 publications

A Multicentric European Clinical Study on Custom-Made Porous Hydroxyapatite Cranioplasty in a Pediatric Population

A Multicentric European Clinical Study on Custom-Made Porous Hydroxyapatite Cranioplasty in a Pediatric Population

Wide Anterior Maxillary Reconstruction with Equine Bone Xenograft: A Case Report of 24-Month Follow-Up

Low-Cost Cranioplasty—A Systematic Review of 3D Printing in Medicine

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