Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon Cedex, France.
Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon Cedex, France; Department of Pediatric Neurology, Hôpital Femme Mère Enfant, Lyon Cedex, France.
World Neurosurg. 2019 Sep;129:e104-e113. doi: 10.1016/j.wneu.2019.05.052. Epub 2019 May 15.
In pediatric cases, the use of autologous bone tissue to repair cranial bone defects is often impossible. The synthetic hydroxyapatite bone substitute (CustomBone) can be a good alternative, especially in case of a large bone defect that has to be repaired.
This study focuses on a pediatric series of 30 children who underwent cranioplasty with a CustomBone implant. Patient age ranged from 8 months to 16 years, with a mean age of 7 years and 8 months. The most common indication for cranioplasty was posttraumatic decompressive craniectomy.
No complications were reported. Cosmetic results were satisfactory in every patient. Only 1 implant had to be changed after severe head trauma because of an epileptic seizure in the early postoperative period. In all patients, cerebral blood flow improved during the postoperative phase. Complete implant osteointegration is a long process because mean time to begin was 13 months (range, 3-22 months). Mean patient follow-up was 6.7 years. Successful prosthesis integration depends on the accuracy of the preoperative model. The minimum thickness of the implant (4 mm) represents a challenge in very young children, but we used it with success in this series. Moreover, high costs represent another limitation for its use.
The CustomBone implant meets all necessary conditions for good clinical outcome: excellent protective properties, restoration of normal intracranial physiology, satisfactory cosmetic results, good integration in the autologous bone, and good resistance in case of trauma.
在儿科病例中，使用自体骨组织修复颅骨骨缺损往往是不可能的。合成羟磷灰石骨替代物（CustomBone）可以作为一种很好的替代物，尤其是在需要修复大的骨缺损的情况下。
本研究专注于 30 例接受 CustomBone 植入物颅骨成形术的儿科患者系列。患者年龄 8 个月至 16 岁，平均年龄为 7 岁 8 个月。颅骨成形术最常见的指征是创伤后减压性颅骨切除术。
未报告任何并发症。每位患者的美容效果都令人满意。只有 1 例因术后早期癫痫发作而严重头部外伤后更换了植入物。在所有患者中，在术后阶段脑血流都得到了改善。完全的植入物骨整合是一个漫长的过程，因为开始的平均时间为 13 个月（范围 3-22 个月）。平均患者随访时间为 6.7 年。成功的假体整合取决于术前模型的准确性。植入物的最小厚度（4 毫米）在非常年幼的儿童中是一个挑战，但在本系列中我们成功地使用了它。此外，高成本也是其使用的另一个限制因素。
CustomBone 植入物满足了良好临床结果的所有必要条件：出色的保护性能、恢复正常颅内生理学、令人满意的美容效果、与自体骨的良好整合以及在创伤情况下的良好抵抗力。
