Fiaschi Pietro, Pavanello Marco, Imperato Alessia, Dallolio Villiam, Accogli Andrea, Capra Valeria, Consales Alessandro, Cama Armando, Piatelli Gianluca
Department of Neurosurgery, San Martino - IST University Hospital (IRCCS), Genoa;
Department of Neuroscience, University of Turin, Italy.
J Neurosurg Pediatr. 2016 Jun;17(6):705-10. doi: 10.3171/2015.10.PEDS15489. Epub 2016 Jan 29.
OBJECTIVE Cranioplasty is a reconstructive procedure used to restore skull anatomy and repair skull defects. Optimal skull reconstruction is a challenge for neurosurgeons, and the strategy used to achieve the best result remains a topic of debate, especially in pediatric patients for whom the continuing skull growth makes the choice of material more difficult. When the native bone flap, which is universally accepted as the preferred option in pediatric patients, is unavailable, the authors' choice of prosthetic material is a polymethylmethacrylate (PMMA) implant designed using a custom-made technique. In this paper the authors present the results of their clinical series of 12 custom-made PMMA implants in pediatric patients. METHODS A retrospective study of the patients who had undergone cranioplasty at Gaslini Children's Hospital between 2006 and 2013 was conducted. A total of 12 consecutive cranioplasties in 12 patients was reviewed, in which a patient-specific PMMA implant was manufactured using a virtual 3D model and then transformed into a physical model using selective laser sintering or 3D printing. All patients or parents were administered a questionnaire to assess how the patient/parent judged the aesthetic result. RESULTS Patient age at craniectomy ranged from 5 months to 12.5 years, with a mean age of 84.33 months at cranioplasty. The mean extension of the custom-made plastic was 56.83 cm(2). The mean time between craniectomy and cranioplasty was 9.25 months. The mean follow-up duration was 55.7 months. No major complications were recorded; 3 patients experienced minor/moderate complications (prosthesis dislocation, granuloma formation, and fluid collection). CONCLUSIONS In this patient series, PMMA resulted in an extremely low complication rate and the custom-made technique was associated with an excellent grade of patient or parent satisfaction on long-term follow up.
目的 颅骨成形术是一种用于恢复颅骨解剖结构和修复颅骨缺损的重建手术。最佳的颅骨重建对神经外科医生来说是一项挑战，实现最佳效果所采用的策略仍是一个争论的话题，尤其是在儿科患者中，持续的颅骨生长使得材料的选择更加困难。当自体骨瓣（在儿科患者中普遍被认为是首选）无法使用时，作者选择的假体材料是采用定制技术设计的聚甲基丙烯酸甲酯（PMMA）植入物。本文作者展示了他们在儿科患者中使用12个定制PMMA植入物的临床系列结果。
方法 对2006年至2013年期间在加斯利尼儿童医院接受颅骨成形术的患者进行回顾性研究。回顾了12例患者的12次连续颅骨成形术，其中使用虚拟3D模型制造患者特异性PMMA植入物，然后使用选择性激光烧结或3D打印将其转化为物理模型。向所有患者或家长发放问卷，以评估患者/家长对美学效果的评价。
结果 颅骨切除术时患者年龄从5个月至12.5岁不等，颅骨成形术时平均年龄为84.33个月。定制塑料的平均面积为56.83平方厘米。颅骨切除术与颅骨成形术之间的平均时间为9.25个月。平均随访时间为55.7个月。未记录到重大并发症；3例患者出现轻微/中度并发症（假体脱位、肉芽肿形成和积液）。
结论 在该患者系列中，PMMA导致极低的并发症发生率，并且定制技术在长期随访中与患者或家长的高度满意度相关。
