Kayhan Sait, Kırmızıgöz Şahin, Kırık Alparslan, Tehli Özkan, İzci Yusuf
Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey.
Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey.
World Neurosurg. 2024 Nov;191:e465-e472. doi: 10.1016/j.wneu.2024.08.154. Epub 2024 Sep 4.
Graft failure is a common complication of cranioplasty. Revision cranioplasty is required to overcome this complication. However, no previous studies have reported outcomes in revision cranioplasty with 3-dimensional (3D) custom-made titanium implants. We describe our experience with 3D titanium implants in patients with revision cranioplasty.
We evaluated 43 consecutive patients between January 2011 and December 2019 who underwent revision cranioplasty using 3D custom-made titanium implants. The 3D image of the patient's cranium and the plan to close the cranium defect were created in a virtual environment using software programs. Demographic and radiologic features were compared based on the materials used in the initial cranioplasty.
Previous material was autologous graft (AG) in 27 patients and polymethyl methacrylate (PMMA) in 16 patients. The mean time without revision cranioplasty is longer in patients with PMMA implants than in patients with AG. There was no statistically significant difference in the length of hospital stay between patients with PMMA implants and patients with AG. There were no postoperative adverse events such as infection, wound dehiscence, convulsions, or epidural hematoma in 38 patients during hospitalization. Wound dehiscence developed in 5 patients and surgical repair was required in one.
Initial cranioplasty with PMMA provides a longer time period than the AG before the revision. However, both of them have similar outcomes based on length of hospital stay and cranial defect area. Custom-made 3D titanium implant is a good option for revision cranioplasty to prevent implant failure and reduce patients' cosmetic concerns.
颅骨修补术失败是颅骨成形术的常见并发症。需要进行翻修颅骨成形术来克服这一并发症。然而，此前尚无研究报道三维（3D）定制钛植入物用于翻修颅骨成形术的结果。我们描述了3D钛植入物用于翻修颅骨成形术患者的经验。
我们评估了2011年1月至2019年12月期间连续43例行3D定制钛植入物翻修颅骨成形术的患者。使用软件程序在虚拟环境中创建患者颅骨的3D图像以及闭合颅骨缺损的方案。根据初次颅骨成形术所用材料比较人口统计学和放射学特征。
先前使用自体移植物（AG）的患者有27例，使用聚甲基丙烯酸甲酯（PMMA）的患者有16例。PMMA植入物患者在无需进行翻修颅骨成形术的平均时间比AG植入物患者更长。PMMA植入物患者与AG植入物患者的住院时间无统计学显著差异。38例患者住院期间未发生感染、伤口裂开、抽搐或硬膜外血肿等术后不良事件。5例患者出现伤口裂开，其中1例需要手术修复。
初次颅骨成形术使用PMMA比AG在翻修前提供更长的时间间隔。然而，基于住院时间和颅骨缺损面积，两者的结果相似。定制3D钛植入物是翻修颅骨成形术防止植入物失败并减少患者美容顾虑的良好选择。
