Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, MD.
Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, MD.
J Craniofac Surg. 2023;34(1):414-416. doi: 10.1097/SCS.0000000000009125. Epub 2022 Nov 24.
Prior to Dr. Paul Tessier's teachings in the 1960's, many neurosurgeons and craniofacial surgeons took shortcuts and employed alloplastic materials fraught with complication, and soon thereafter, both surgical specialties moved the pendulum towards the side of bone grafts being the gold standard for neurosurgical reconstruction and the art of cranioplasty. But now half a century later, neuroplastic surgery is moving the pendulum the other way. Without a doubt, the brain is a critical organ that needs some form of modulation as opposed to replacement. The intervention delivered can be in the form of electricity, light, medicine, etc. Regardless of the medium, it needs to be housed somewhere. And there is no better real estate than to be housed within a sterile alloplastic case with embedded smart technologies; in a way that prevents obvious, visual deformity. For example, it would be naïve to think that the future of embedded neurotechnologies will one day be housed safely and dependably within one's own bone flap. Hence, moving forward, time-tested alloplastic materials will become the new gold standard for cranioplasty reconstruction as the world starts to welcome a generation of smart cranial devices; some of which may house Bluetooth-connected, Wifi-enabled, MRI-compatible pumps to perform convection-enhanced delivery of time-tested medicines - thereby forever changing the way we approach chronic neurological disease and the forever-obstructing, blood-brain barrier. As this happens, I feel confident saying that both Tessier and Cushing are somewhere applauding and smiling on these efforts.
在保罗·泰西尔博士（Paul Tessier）教授于 20 世纪 60 年代的教学之前，许多神经外科医生和颅面外科医生都走了捷径，使用了充满并发症的同种异体材料，此后不久，这两个外科专业都将神经外科重建的金标准和颅骨成形术的艺术转向了骨移植物。但现在半个世纪过去了，神经塑性手术正在朝着另一个方向摆动。毫无疑问，大脑是一个关键器官，需要某种形式的调节，而不是替代。可以通过电、光、药物等形式进行干预。无论采用哪种媒介，都需要将其安置在某个地方。没有比将其放置在带有嵌入式智能技术的无菌同种异体外壳中更好的地方了；以一种防止明显的视觉畸形的方式。例如，天真地认为嵌入式神经技术的未来有一天会安全可靠地安置在自己的骨瓣内，这是不现实的。因此，随着时间的推移，经过时间考验的同种异体材料将成为颅骨成形术重建的新标准，因为世界开始欢迎新一代智能颅骨设备；其中一些可能会容纳蓝牙连接、Wi-Fi 功能、MRI 兼容的泵，以进行经对流增强的时间考验药物的输送——从而永远改变我们治疗慢性神经疾病和永远阻塞的血脑屏障的方式。随着这一情况的发生，我有信心地说，泰西尔和库欣都在为这些努力鼓掌和微笑。
