Huang Gary J, Zhong Susan, Susarla Srinivas M, Swanson Edward W, Huang Judy, Gordon Chad R
From the *The University of Illinois College of Medicine, Rockford, Illinois; and Departments of †Plastic and Reconstructive Surgery and ‡Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Craniofac Surg. 2015 Jan;26(1):64-70. doi: 10.1097/SCS.0000000000001315.
Secondary cranioplasty with customized craniofacial implants (CCIs) are often used to restore cerebral protection and reverse syndromes of the trephined, and for reconstruction of acquired cranial deformities. The 2 most widely used implant materials are polyetheretherketone and poly(methylmethacrylate) (PMMA). Previous series with CCIs report several major complications, including implant infection leading to removal, extended hospital stays, and surgical revisions. With this in mind, we chose to review our large case series of 22 consecutive PMMA CCI cranioplasties treated by a single craniofacial surgeon.
A cohort of 20 consecutive patients receiving 22 PMMA implants during a 2-year period was identified and outcomes reviewed. The mechanism of initial insult, time from craniectomy to cranioplasty, anesthesia time, major and minor postoperative complications, radiation history, and length of follow-up were statistically analyzed.
There were no complications related to infection, hematoma/seroma, or cerebrospinal fluid leak (0/22, 0%). Two patients experienced major complications related to persistent temporal hollowing (PTH) following standard CCI cranioplasty, which required revision surgery with modified implants (2/22, 9%). One minor complication of self-resolving transient diplopia was noted (1/22, 5%).
In this consecutive series, PMMA CCIs were associated with a very low complication rate, suggesting that PMMA may be a preferred material for CCI fabrication. However, with 10% (2/20) of patients experiencing PTH and dissatisfaction related to asymmetry, future research must be directed at modifying CCI shape, to address the overlying soft-tissue deformity. If successful, this may increase patient satisfaction, prevent PTH, and avoid additional costs of revision surgery.
使用定制颅面植入物（CCIs）进行二期颅骨成形术常用于恢复脑保护功能、纠正颅骨钻孔综合征以及修复后天性颅骨畸形。两种使用最广泛的植入材料是聚醚醚酮和聚甲基丙烯酸甲酯（PMMA）。此前关于CCIs的系列报道了几种主要并发症，包括导致植入物取出的感染、住院时间延长和手术翻修。考虑到这一点，我们选择回顾由一位颅面外科医生连续治疗的22例PMMA CCI颅骨成形术的大型病例系列。
确定了一组在两年期间接受22枚PMMA植入物的连续20例患者，并对结果进行回顾。对初始损伤机制、颅骨切除至颅骨成形术的时间、麻醉时间、术后主要和次要并发症、放疗史以及随访时间进行了统计分析。
未发生与感染、血肿/血清肿或脑脊液漏相关的并发症（0/22，0%）。两名患者在标准CCI颅骨成形术后出现与持续性颞部凹陷（PTH）相关的主要并发症，需要使用改良植入物进行翻修手术（2/22，9%）。记录到1例自行缓解的短暂性复视轻微并发症（1/22，5%）。
在这个连续系列中，PMMA CCIs的并发症发生率非常低，表明PMMA可能是制造CCI的首选材料。然而，10%（2/20）的患者出现PTH并因不对称而不满意，未来的研究必须致力于改进CCI形状，以解决覆盖的软组织畸形问题。如果成功，这可能会提高患者满意度，预防PTH，并避免翻修手术的额外费用。
