Amin Md Rezaul, Islam Km Tarikul, Haque Moududul
Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Surg Neurol Int. 2024 Jul 12;15:241. doi: 10.25259/SNI_250_2024. eCollection 2024.
Common calvarial lesions include fibrous dysplasia (FD), intraosseous meningioma, osteoma, Langerhans cell histiocytosis (LCH), intraosseous hemangioma, dermoid and epidermoid cyst, and malignancy. Surgical removal with removal of the involved skull is the choice of treatment for these lesions. Previously, the skull defect was repaired using allograft, and alloplastic materials have been replaced with newer polyetheretherketone (PEEK) material, which is more resistant, biocompatible, and can be 3-dimension (3D)--printed. High-resolution 3D printing uses very fine extruders to put materials in fine layers to recreate patients' anatomy authentically, which gives superior cosmetic outcomes. Our objectives were preoperative planning of craniectomy and reconstruction for calvarial lesions and reconstruction of skull defects using 3D-printed cranioplasty with PEEK materials.
In this series, we describe 11 cases in which skull lesions were removed and reconstructed in the same sitting using a 3D-printed PEEK implant designed preoperatively using high-resolution computer tomography. All the cases were done in the neurosurgery department of Bangabandhu Sheikh Mujib Medical University from 2021 to 2023. Patients were followed up for 6 months after surgery.
Regarding 11 cases, six cases were FD, three cases were intraosseous meningioma, one case was intraosseous hemangioma, and one case was LCH. Average lesion size were 12.73-5.77 cm. Cranioplasty was done with PEEK material. Minor complications were treated conservatively. Seroma, postoperative fever, and nausea were among these.
The human bone-like biocompatibility and resistance to physical forces leads to more frequent use of PEEK, which enables to repair of complex craniofacial defects with better cosmesis. Despite some limitations, the PEEK cranioplasty implant continued to thrive and showed its promise to be an excellent material. Further, research and investment should be put into developing the technique.
常见的颅骨病变包括骨纤维异常增殖症（FD）、骨内脑膜瘤、骨瘤、朗格汉斯细胞组织细胞增多症（LCH）、骨内血管瘤、皮样囊肿和表皮样囊肿以及恶性肿瘤。手术切除病变颅骨是这些病变的首选治疗方法。以前，颅骨缺损采用同种异体骨修复，而异体材料已被更新的聚醚醚酮（PEEK）材料取代，后者更具耐受性、生物相容性更好，并且可以进行三维（3D）打印。高分辨率3D打印使用非常精细的挤出机将材料分层放置，以逼真地重建患者的解剖结构，从而获得更好的美容效果。我们的目标是对颅骨病变进行颅骨切除术和重建的术前规划，并使用3D打印的PEEK材料进行颅骨缺损重建。
在本系列研究中，我们描述了11例患者，这些患者在同一手术中切除颅骨病变并使用术前通过高分辨率计算机断层扫描设计的3D打印PEEK植入物进行重建。所有病例均于2021年至2023年在孟加拉国谢赫·穆吉布医学大学神经外科完成。患者术后随访6个月。
11例患者中，6例为骨纤维异常增殖症，3例为骨内脑膜瘤，1例为骨内血管瘤，1例为朗格汉斯细胞组织细胞增多症。平均病变大小为12.73 - 5.77厘米。采用PEEK材料进行颅骨成形术。轻微并发症采用保守治疗。包括血清肿、术后发热和恶心等。
PEEK具有类似人体骨骼的生物相容性和对物理力的耐受性，因此使用频率更高，能够更好地修复复杂的颅面缺损并具有更好的美容效果。尽管存在一些局限性，但PEEK颅骨成形术植入物仍在不断发展，并有望成为一种优秀的材料。此外，应投入研究和投资来改进该技术。
