Talamonti Giuseppe, Crisà Francesco, Canzi Gabriele
Department of Neurosurgery, Niguarda Ca'Granda Hospital, Milan, Italy,
Department of Neurosurgery, Niguarda Ca'Granda Hospital, Milan, Italy.
Pediatr Neurosurg. 2019;54(3):218-222. doi: 10.1159/000496694. Epub 2019 Mar 15.
Large cranial defects in very young patients are challenging. The ideal material for cranioplasty in this age group has not yet been identified. Cryopreserved autologous bone presents very high rates of failures, acrylic resins pose a number of compatibility problems, bioceramics may be contraindicated, and autografts may be not adequate for repair of large defects. We present an 18-month-old baby with a large post-traumatic cranial defect which was repaired by assembling a new bone flap on a sterile stereolithographic 3-D model. This customized newly assembled flap consisted of a scaffold of autologous bone (from vault duplication) sustaining 2 large grafts of homologous cadaveric bone. It was adequately modeled and contoured on the 3-D model using metallic plates and screws. Immediately after implantation on the skull, the metallic devices were progressively replaced by reabsorbable material, thus maintaining the previously obtained flap profile. In this paper we detail this original technique which was developed to manage this specific patient.
对于非常年幼的患者而言，大型颅骨缺损是一项具有挑战性的难题。目前尚未确定该年龄组颅骨成形术的理想材料。冷冻保存的自体骨失败率极高，丙烯酸树脂存在诸多兼容性问题，生物陶瓷可能存在禁忌，而异体骨可能不足以修复大型缺损。我们报告了一名18个月大的婴儿，其患有大型创伤后颅骨缺损，通过在无菌立体光刻3D模型上组装新的骨瓣进行修复。这种定制的新组装骨瓣由自体骨支架（来自颅骨复制）支撑2块大型同种异体尸体骨移植而成。使用金属板和螺钉在3D模型上对其进行了充分的塑形和轮廓调整。在植入颅骨后，金属装置立即逐渐被可吸收材料取代，从而保持先前获得的骨瓣轮廓。在本文中，我们详细介绍了为治疗这名特定患者而开发的这项原创技术。
