Fricia Marco, Nicolosi Federico, Ganau Mario, Cebula Helene, Todeschi Julien, Santin Marie des Neiges, Nannavecchia Benny, Morselli Carlotta, Chibbaro Salvatore
Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy.
Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano, Italy.
World Neurosurg. 2019 Jan;121:160-165. doi: 10.1016/j.wneu.2018.09.199. Epub 2018 Oct 11.
Despite the mixed evidence regarding the effect of decompressive craniectomy in terms of outcome, a tremendous increase in related reports has been observed in the last years. Cranioplasty plays a key role in restoring function and anatomy of the cranial vault. Considering that cranioplasty is not exempt from risks, the identification of the safest technique becomes crucial to achieve better patients' recovery. Porous hydroxyapatite (PHA) has received growing attention for its potential in bony integration. Here we report a multicenter prospective follow-up analysis of 149 patients who underwent cranioplasty with PHA prostheses. In particular, we focus on the incidence of adverse events and implant removal.
From January 2001 to December 2015 we conducted a prospective multicenter study of 149 patients who underwent cranioplasty with custom-made PHA flaps after decompressive craniectomy for several reasons. The endpoints were the incidence of adverse events after cranioplasty and of related implant removal.
66 patients (44%) were treated within 6 months from decompression, and only 2 patients had a bifrontal bilateral reconstruction. Of those, 25 patients reported complications (16.8%), and 9 of them (6% of the whole case series) required removal of the prosthesis. The only significant factor predicting cranioplasty removal was a previous infection.
Hydroxyapatite for cranial implants is fully comparable to other heterologous materials. It has a biologic potential of bony integration. The risk of explants seems to be significantly higher in second-line patients, data not shown in previous studies.
尽管减压性颅骨切除术在疗效方面的证据不一，但近年来相关报道仍大幅增加。颅骨成形术在恢复颅顶功能和解剖结构方面起着关键作用。鉴于颅骨成形术并非没有风险，确定最安全的技术对于患者更好地康复至关重要。多孔羟基磷灰石（PHA）因其在骨整合方面的潜力而受到越来越多的关注。在此，我们报告了一项对149例行PHA假体颅骨成形术患者的多中心前瞻性随访分析。我们特别关注不良事件的发生率和植入物取出情况。
从2001年1月至2015年12月，我们对149例因多种原因在减压性颅骨切除术后行定制PHA瓣颅骨成形术的患者进行了一项前瞻性多中心研究。终点指标为颅骨成形术后不良事件的发生率及相关植入物取出情况。
66例患者（44%）在减压后6个月内接受治疗，仅2例患者进行了双侧额部重建。其中，25例患者报告出现并发症（16.8%），其中9例（占整个病例系列的6%）需要取出假体。预测颅骨成形术植入物取出的唯一重要因素是既往感染。
用于颅骨植入的羟基磷灰石与其他异种材料完全可比。它具有骨整合的生物学潜力。二线患者的植入物取出风险似乎明显更高，此前研究未显示相关数据。
