Frassanito Paolo, Tamburrini Gianpiero, Massimi Luca, Peraio Simone, Caldarelli Massimo, Di Rocco Concezio
Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, Catholic University Medical School, Largo A. Gemelli, 8, 00168, Rome, Italy.
Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany.
Childs Nerv Syst. 2017 Oct;33(10):1759-1768. doi: 10.1007/s00381-017-3541-8. Epub 2017 Sep 6.
Cranial repair after traumatic brain injury in children is still burdened by unsolved problems and controversial issues, mainly due to the high rate of resorption of autologous bone as well as the absence of valid alternative material to replace the autologous bone. Indeed, inert biomaterials are associated to satisfactory results in the short period but bear the continuous risk of complications related to the lack of osteointegration capacity. Biomimetic materials claiming osteoconductive properties that could balance their mechanical limits seem to allow good cranial bone reconstruction. However, these results should be confirmed in the long term and in larger series. Further complicating factors that may affect cranial reconstruction after head injury should be identified in the possible associated alterations of CSF dynamics and in difficulties to manage the traumatic skin lesion and the surgical wound, which also might impact on the cranioplasty outcome. All the abovementioned considerations should be taken into account when dealing with the cranial reconstruction after decompressive craniectomy in children.
儿童创伤性脑损伤后的颅骨修复仍然存在一些未解决的问题和有争议的问题，主要原因是自体骨吸收率高，以及缺乏有效的替代材料来替代自体骨。事实上，惰性生物材料在短期内能带来令人满意的结果，但存在与缺乏骨整合能力相关的持续并发症风险。声称具有骨传导特性以平衡其机械局限性的仿生材料似乎能实现良好的颅骨重建。然而，这些结果需要长期和更大规模的研究系列来证实。在处理头部损伤后的颅骨重建时，还应考虑到可能影响颅骨重建的其他复杂因素，包括脑脊液动力学的可能相关改变，以及处理创伤性皮肤损伤和手术伤口的困难，这些也可能影响颅骨成形术的结果。在处理儿童减压性颅骨切除术后的颅骨重建时，应考虑到上述所有因素。
