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A cranioplastia para os tratamentos de defeitos ósseos cranianos tem como o seu principal objetivo a reconstrução tridimensional e funcional da calota craniana. As cirurgias assistidas por computador (CAS) vem sendo utilizadas desde os anos 90 de forma eficiente e trazendo melhorias e otimização nas abordagens cirúrgicas craniofaciais reconstrutivas, principalmente em grandes defeitos ósseos. Este relato de caso clínico aborda o planejamento virtual e de tecnologia CAD/CAM na reconstrução craniofacial secundária com a utilização de polimetilmetacrilato (PMMA). Paciente de sexo masculino, 48 anos, apresentava dois defeitos ósseos em região frontal com deiscência da pele para dentro do seio frontal. Foi realizada uma tomografia computadorizada com cortes de 1mm e convertidos em um modelo 3D do osso frontal e no molde do defeito ósseo em tamanho real. Para abordagem dos defeitos ósseos, houve a participação de um neurocirurgião para o tratamento em dura-máter, cranialização do seio frontal e obliteração do ducto naso-frontal, sendo finalizada pela equipe de cirurgia bucomaxilofacial. Após a cirurgia, foi realizado um exame tomográfico sendo observados uma perfeita adaptação entre a prótese e os contornos ósseos e um ótimo contorno anatômico do osso frontal, tornando-se satisfatório ao planejamento cirúrgico inicial. A utilização de um planejamento virtual e do sistema CAD/CAM resultou em uma maior previsibilidade e maior segurança ao procedimento de reconstrução craniofacial além de redução do tempo transoperatório. O material utilizado, o PMMA, apresentou-se como um material de fácil manipulação, baixo custo e com perfeita adaptação aos contornos ósseos.
Cranioplasty for the treatment of cranial bone defects has as its main objective the three-dimensional and functional reconstruction of the skull. Computer-assisted surgeries (CAS) have been used since the 1990s efficiently and bring improvements and optimization in reconstructive craniofacial surgical approaches, especially in large bone defects. This clinical case report addresses virtual planning and CAD/CAM technology in secondary craniofacial reconstruction using polymethylmethacrylate (PMMA). A 48-year-old male patient had two bone defects in the frontal region with skin dehiscence into the frontal sinus. A computed tomography was performed with 1mm slices and converted into a 3D model of the frontal bone and in the mold of the bone defect in real size. To address the bone defects, a neurosurgeon was involved in the treatment of dura mater, cranialization of the frontal sinus, and obliteration of the nasofrontal duct, and was completed by the oral and maxillofacial surgery team. After the surgery, a tomographic exam was performed, and a perfect adaptation between the prosthesis and the bone contours and a great anatomical contour of the frontal bone were observed, making it satisfactory to the initial surgical planning. The use of virtual planning and the CAD/CAM system resulted in greater predictability and greater safety for the craniofacial reconstruction procedure, as well as a reduction in the perioperative time. The material used, PMMA, presented itself as a material of easy manipulation, low cost, and with perfect adaptation to bone contours.Keywords: PMMA, Bone transplantation, Maxillofacial Prosthesis, Cranioplasty, Customized implants.
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RESUMEN La craneoplastia es la reconstrucción de los elementos cutáneos, óseos, y meningeos que resguardan los elementos nobles del cráneo usando materiales aloplásticos, la búsqueda de la mejor alternativa a estos nos llevó a desarrollar una técnica que utiliza los propios tejidos peri lesiónales, practicada en un paciente, que luego de 15 días de haber sufrido un traumatismo con herramienta cortante que expuso tejidos nobles intracraneales comprometiendo su vida. Se realizó la reconstrucción de la bóveda craneal en un solo tiempo quirúrgico. Esta técnica permitió alcanzar resultados satisfactorios, logrando evitar rechazos de los materiales utilizados frecuente en otras técnicas.
ABSTRACT Cranioplasty is the reconstruction of the skin, bone, and meningeal elements that protect the noble elements of the skull using alloplastic materials, the search for the best alternative to these led us to develop a technique that uses the peri-lesion tissues themselves, practiced in a patient, who after 15 days of having suffered a trauma with a cutting tool that exposed intracranial noble tissues, compromising his life. Reconstruction of the cranial vault was performed in a single surgical time. This technique allowed to achieve satisfactory results, managing to avoid rejections of the materials used frequently in other techniques.
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Objective To investigate the clinical effects and complications of different period cranioplasty after decompressive craniectomy in patients with craniocerebral injury.Methods The clinical data of 96 craniocerebral injury patients who had underwent decompressive craniectomy in the First Affiliated Hospital of Chengdu Medical College from January 2014 to January 2018 were retrospectively analyzed.According to the different time of cranioplasty,the patients were divided into early group and routine group.In the early group,50 patients received cranioplasty between 1.5 to 3.0 months after decompressive craniectomy;while in the conventional group,46 patients received cranioplasty between 3.1 to 6.0 months after decompressive craniectomy.The complications after cranioplasty were observed in 2 groups,and Glasgow outcome score (GOS) and Karnofsky performance score (KPS) before cranioplasty and 3,6 and 12 months after cranioplasty were recorded.Results There were no statistical difference in delayed wound healing,subcutaneous hydrops,incision infection,hydrocephalus,intracranial hemorrhage and total incidence of complications between 2 groups (P ＞ 0.05).However,the incidence of postoperative epilepsy in early group was significantly lower than that in routine group:0 vs.8.70％ (4/46),and there was statistical difference (P ＜ 0.05).There were no statistical differences in GOS and KPS before cranioplasty between 2 groups (P ＞ 0.05);the GOS and KPS 3,6 and 12 months after cranioplasty in early group were significantly higher than those in routine group,GOS:(3.58 ± 0.64) scores vs.(3.20 ± 0.74) scores,(3.90 ± 0.58) scores vs.(3.61 ± 0.61) scores and (4.22 ± 0.55) scores vs.(3.98 ± 0.45) scores;KPS:(56.20 ± 8.55) scores vs.(52.17 ± 7.86) scores,(68.40 ± 9.12) scores vs.(63.91 ± 10.22) scores and (75.20 ± 9.31) scores vs.(70.43 ± 10.53) scores,and there were statistical differences (P＜0.01 or ＜0.05).Conclusions Early cranioplasty after decompressive craniectomy in patients with craniocerebral injury can not only reduce the incidence of postoperative epilepsy,but also be more conducive to the recovery of postoperative neurological function and improve the prognosis of patients.
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Objective@#To investigate the clinical effects and complications of different period cranioplasty after decompressive craniectomy in patients with craniocerebral injury.@*Methods@#The clinical data of 96 craniocerebral injury patients who had underwent decompressive craniectomy in the First Affiliated Hospital of Chengdu Medical College from January 2014 to January 2018 were retrospectively analyzed. According to the different time of cranioplasty, the patients were divided into early group and routine group. In the early group, 50 patients received cranioplasty between 1.5 to 3.0 months after decompressive craniectomy; while in the conventional group, 46 patients received cranioplasty between 3.1 to 6.0 months after decompressive craniectomy. The complications after cranioplasty were observed in 2 groups, and Glasgow outcome score (GOS) and Karnofsky performance score (KPS) before cranioplasty and 3, 6 and 12 months after cranioplasty were recorded.@*Results@#There were no statistical difference in delayed wound healing, subcutaneous hydrops, incision infection, hydrocephalus, intracranial hemorrhage and total incidence of complications between 2 groups (P>0.05). However, the incidence of postoperative epilepsy in early group was significantly lower than that in routine group: 0 vs. 8.70% (4/46), and there was statistical difference (P<0.05). There were no statistical differences in GOS and KPS before cranioplasty between 2 groups (P>0.05); the GOS and KPS 3, 6 and 12 months after cranioplasty in early group were significantly higher than those in routine group, GOS: (3.58 ± 0.64) scores vs. (3.20 ± 0.74) scores, (3.90 ± 0.58) scores vs. (3.61 ± 0.61) scores and (4.22 ± 0.55) scores vs. (3.98 ± 0.45) scores; KPS: (56.20 ± 8.55) scores vs. (52.17 ± 7.86) scores, (68.40 ± 9.12) scores vs. (63.91 ± 10.22) scores and (75.20 ± 9.31) scores vs. (70.43 ± 10.53) scores, and there were statistical differences (P<0.01 or <0.05).@*Conclusions@#Early cranioplasty after decompressive craniectomy in patients with craniocerebral injury can not only reduce the incidence of postoperative epilepsy, but also be more conducive to the recovery of postoperative neurological function and improve the prognosis of patients.
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Objective@#To explore the therapeutic effect of subcutaneous negative pressure drainage and absorbable suture in preventing postoperative complications of cranioplasty.@*Methods@#The clinical data of 175 cases of skull defect admitted and treated in Department of Neurosurgeryof the Affiliated Hospital of Binzhou Medical University from January 2012 to February 2018 were retrospectively analyzed.According to the different intraoperative treatment methods, 97 cases were treated with thread suture to the galea aponeurotica combined with general drainage(the general drainage group), and 78 cases were treated with absorbable suture to the galea aponeurotica combined with negative pressure drainage(the negative pressure drainage group). The galea aponeurotica were sutured intermittently with both silk thread and absorbable suture, and the drainage tube was placed outside the metal titanium plate under the skin, and removed after 48-72 hours.The postoperative complications of the two groups were compared.@*Results@#The incidence rates of subcutaneous hemorrhage, knotting reaction, infection of incision in the negative pressure drainage group were 1.3%(1/78), 0.0%(0/78), and 0.0%(0/78), respectively, which were significantly lower than those in the average drainage group[11.3%(11/97), 20.6%(20/97), 7.2%(7/97)], the differences were statistically significant(χ2=6.85, 18.16, 4.13, all P<0.05).@*Conclusion@#The application of absorbable suture suturing galea aponeurotica and subcutaneous negative pressure drainage in skull repair can significantly reduce and prevent postoperative complications of cranioplasty.
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PURPOSE: Bone flap resorption (BFR) after cranioplasty with an autologous bone flap (ABF) is well known. However, the prevalences and degrees of BFR remain unclear. This study aimed to evaluate changes in ABFs following cranioplasty and to investigate factors related with BFR. MATERIALS AND METHODS: We retrospectively reviewed 97 patients who underwent cranioplasty with frozen ABF between January 2007 and December 2016. Brain CT images of these patients were reconstructed to form three-dimensional (3D) images, and 3D images of ABF were separated using medical image editing software. ABF volumes on images were measured using 3D image editing software and were compared between images in the immediate postoperative period and at postoperative 12 months. Risk factors related with BFR were also analyzed. RESULTS: The volumes of bone flaps calculated from CT images immediately after cranioplasty ranged from 55.3 cm³ to 175 cm³. Remnant bone flap volumes at postoperative 12 months ranged from 14.2% to 102.5% of the original volume. Seventy-five patients (77.3%) had a BFR rate exceeding 10% at 12 months after cranioplasty, and 26 patients (26.8%) presented severe BFR over 40%. Ten patients (10.3%) underwent repeated cranioplasty due to severe BFR. The use of a 5-mm burr for central tack-up sutures was significantly associated with BFR (p<0.001). CONCLUSION: Most ABFs after cranioplasty are absorbed. Thus, when using frozen ABF, patients should be adequately informed. To prevent BFR, making holes must be kept to a minimum during ABF grafting.
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Humans , Autografts , Bone Resorption , Brain , Decompressive Craniectomy , Postoperative Period , Prevalence , Retrospective Studies , Risk Factors , Skull , Sutures , TransplantsABSTRACT
Objective To explore the therapeutic effect of subcutaneous negative pressure drainage and absorbable suture in preventing postoperative complications of cranioplasty.Methods The clinical data of 175 cases of skull defect admitted and treated in Department of Neurosurgeryof the Affiliated Hospital of Binzhou Medical University from January 2012 to February 2018 were retrospectively analyzed.According to the different intraoperative treatment methods,97 cases were treated with thread suture to the galea aponeurotica combined with general drainage (the general drainage group),and 78 cases were treated with absorbable suture to the galea aponeurotica combined with negative pressure drainage(the negative pressure drainage group).The galea aponeurotica were sutured intermittently with both silk thread and absorbable suture,and the drainage tube was placed outside the metal titanium plate under the skin,and removed after 48-72 hours.The postoperative complications of the two groups were compared.Results The incidence rates of subcutaneous hemorrhage,knotting reaction,infection of incision in the negative pressure drainage group were 1.3％ (1/78),0.0％ (0/78),and 0.0％ (0/78),respectively,which were significantly lower than those in the average drainage group [11.3％ (11/97),20.6％ (20/97),7.2％ (7/97)],the differences were statistically significant (x2 =6.85,18.16,4.13,all P ＜ 0.05).Conclusion The application of absorbable suture suturing galea aponeurotica and subcutaneous negative pressure drainage in skull repair can significantly reduce and prevent postoperative complications of cranioplasty.
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Cranioplasty is one of the common operations in neurosurgery at present. It can not only restore the integrity of the cranial cavity and meet the aesthetic requirements, but also relieve the clinical symptoms of headache, dizziness, fatigue, mood swings and so on. Cranioplasty can improve cerebral hemodynamics to promote the recovery of neurological function. The researches on relationship between cerebral hemodynamics and clinical symptoms were reported in recent years. However, the results were not consistent. Cranioplasty is recommended as early as permit.
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El síndrome del trefinado o craniectomizado abarca manifestaciones neurológicas asociadas a la depresión del flap cutáneo y se distingue del síndrome postraumático por su reversibilidad con el tratamiento reparador del defecto craneano. El coma no es una forma habitual de presentación. Comunicamos un caso de presentación atípica en un hombre de 36 años de edad con antecedente de craniectomía descompresiva, que presentó un cuadro de deterioro neurológico profundo atribuible al síndrome del trefinado, el cual revirtió tras la craneoplastía. En la fisiopatología del síndrome intervienen trastornos cerebrovasculares, metabólicos, hidrodinámicos del líquido cefalorraquídeo e hiperdinamismo de las estructuras encefálicas. El gold standard terapéutico es la craneoplastía. Se requieren estudios de mayor peso estadístico para determinar el tiempo quirúrgico apropiado.
The syndrome of the trephined or craniectomized is commonly referred as neurological manifestations associated to skin flap depression and reversible after craneoplasty, which allows its differentiation from post-traumatic syndrome. We present the case of a male patient, 36 years old, with history of decompressive craniectomy. He evolved with sudden neurological worsening associated to syndrome of the trephined and recovery after craneoplasty. Physiopathology of the syndrome involves cerebrovascular, metabolic and cerebrospinal fluid hydrodynamic disturbances as well as parenchymal hyperdynamic mechanisms. Cranioplasty is the gold standard treatment. Still, studies with statistical power are needed to assess correct surgical timing.
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Humans , Male , Adult , Trephining/adverse effects , Coma/etiology , Decompressive Craniectomy/adverse effects , Postoperative Complications , Syndrome , Tomography, X-Ray Computed , Coma/diagnostic imagingABSTRACT
Objective To investigate the factors affecting the incidence of epilepsy after cranioplasty.Methods A retrospective case control study was conducted on the clinical data of 171 patients with skull defect who underwent cranioplasty between January 2012 and December 2015.There were 126 males and 45 females,with an average age of 50.9 years (range,16-78 years).The patients were divided into epileptic seizure group (61 cases) and non epileptic seizure group (110 cases).The gender,age,defect cause,defect location,defect duration,perioperative antiepileptic drug use,skull defect regional depression volume (Vd),skull defect regional integrity volume (Vf),skull defect regional depression rate (Pd) of two groups were recorded.Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factor of epilepsy after cranioplasty.Results All patients were followed up for 54 months averagely (range,18-90 months).Sixty-one patients (35.7％) had epilepsy after cranioplasty.Univariate analysis suggested that age,defect cause,defect location,defect duration,perioperative antiepileptic drug use,and Vf were not associated with epilepsy after cranioplasty (all P ＞ 0.05);while gender,Vd,and Pd was associated with epilepsy after cranioplasty (P ＜ 0.05).Multivariate logistic regression analysis demonstrated that Pd (OR =0.024,95％ CI 0.001-0.502,P ＜0.05) was independent predictor of epilepsy after cranioplasty.Conclusion Pd is an independent risk factor for epilepsy after cranioplasty and depression degree could significantly affect its incidence.
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Objective To compare the effect of the bipolar electric coagulation and unipolar electric coagulation on cranioplasty of scalp separation. Methods The clinical data of 67 patients who underwent unilateral frontotemporal cranioplasty from 2014 to 2017 were retrospectively analyzed. According to coagulation method during operation, these patients were divided into two groups, unipolar electric coagulation group (32 cases) and bipolar electric coagulation group (35 cases). The operation time, postoperative intracranial hemorrhage, infection, epilepsy and subcutaneous effusion were compared between two groups. Results The operation time of two groups had no significant difference (P > 0.05). The incidence of intracranial hemorrhage, infection and epilepsy of two groups had no significant differences (P > 0.05). But the incidence of subcutaneous effusion in unipolar electric coagulation group was significantly higher than that in bipolar electric coagulation group: 28.1%(9/32) vs. 5.7%(2/35), P<0.05. Conclusions The use of unipolar electric coagulation during the scalp separation in cranioplasty can reduce operation time in a certain extent, but significantly increase the incidence of postoperative subcutaneous effusion.
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Objective To explore the effects of cranioplasty onneurological functionin patients based on the cerebral CT perfusion technique. Methods Twenty cases of patients receiving cranioplasty were rerecorded during the study period,and they wererespectively scanned by CT perfusion within 72 hours before and 2 weeks after the cranioplasty. Meanwhile,the neurological function was evaluated by neurological function scale. Results The difference of cerebral blood flow before and after cranioplasty was statistically significant(P<0.05), whereas the difference of cerebral blood volume,transit time to the peak and mean transit time was not statistically significant(P>0.05).Correlation analysis showed that the preoperativedifference ratio of thecerebral blood infusio-nis not correlated with the neurological function score(P > 0.05). The changes of preoperative and postoperative difference rateof the cerebral blood infusionwas correlated with the functional independence measure(P < 0.05), whereas not with mini-mental state examination(P > 0.05). Conclusions The neurological function of the patients after cranioplasty may be improved.This improvement may benefit from the improvement of cerebral blood flow after cranioplasty.
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Objective To study on the procedure, safety and effectiveness of polyetheretherketone (PEEK) implant applied to cranioplasty of skull defect. Methods A total of 11 cases (10 male, 1 female) of unilateral skull defect, more than 6 months post operation, were included in this study. PEEK implant was custom-made by three-dimensional numerically controlled processing depended on the data obtained from 1 mm-slice CT scan before cranioplasty individually. Autoclaved implants were applied to cranioplastic surgeries under general anesthesia. Findings of imaging examination and vital signs were compared before and after operation. Vital sign changes and circumstances during procedure were noted, and following-up reviews were performed on 2-week, 3-month and 1 year after operation respectively. Results Wounds healing were uneventful in 11 cases, no postoperative paresthesia presented. Surgical complications including temporary subcutaneous exudates were cleared up by puncture and aspiration in 5 cases, subcutaneous hematoma duo to drainage removal in 1 case, of which an emergency evacuation was performed and the implant was still with instant incision closure and then smooth recovery eventually. No significant abnormal fluctuation of laboratory examination was reported, moreover no artifact interference was found on postoperative CT scan or MR image. The subjective feelings and external sensory effects are satisfactory in patients. No emerging dysfunction of central nervous system or other organs was found, and no long-term complication was appeared. Conclusion It is feasible and safe to apply PEEK implant to cranioplasty without additional operative difficulty. This kind of material is an ideal alternative for repairing skull defect to patients with good financial condition and specific demands for postoperative status especially.
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Cranioplasty is an in evitable operation conducted after decompressive craniectomy (DC). The primary goals of cranioplasty after DC are to protect the brain, achieve a natural appearance and prevent sinking skin flap syndrome (or syndrome of the trephined). Furthermore, restoring patients' functional outcome and supplementing external defects helps patients improve their self-esteem. Although early cranioplasty is preferred in recent year, optimal timing for cranioplasty remains a controversial topic. Autologous bone flaps are the most ideal substitute for cranioplasty. Complications associated with cranioplasty are also variable, however, post-surgical infection is most common. Many new materials and techniques for cranioplasty are introduced. Cost-benefit analysis of these new materials and techniques can result in different outcomes from different healthcare systems.
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Humans , Brain , Cost-Benefit Analysis , Decompressive Craniectomy , Delivery of Health Care , SkinABSTRACT
OBJECTIVE: After a rigorous management of increased intracranial pressure by decompressive craniectomy (DC), cranioplasty (CP) is usually carried out for functional and cosmetic purposes. However, the optimal timing of CP remains controversial. Our study aims to analyze the relationship between the optimal timing of CP and the post-operative complications. METHODS: From January 2013 to December 2015, ninety patients who underwent CP in a single institution were analyzed. We set the independent variables as follows: 1) patient characteristics; 2) the time interval between the DC and CP; 3) operation time; 4) anesthesia time; and 5) pre-operative computed tomography (CT) findings such as a degree of sunken brain by ratio of A (the median length from scalp to midline) to B (the length from midline to inner table of skull at this level). The dependent variables of this study are the event of post-operative complications. RESULTS: The overall complication rate was 33.3%. There was no statistical significance in the time interval between the DC and CP in the groups with and without complications of CP (p=0.632). However, there was a significant statistical difference in the degree of sunken brain by ratio (A/B) between the two groups (p<0.001). CONCLUSION: From this study, we conclude that it is better to determine the optimal timing of CP by the pre-operative CT finding than by the time interval between the DC and CP. Hereby, we suggest a potentially useful determinant of optimal timing of CP.
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Humans , Anesthesia , Brain , Decompressive Craniectomy , Intracranial Pressure , Scalp , SkullABSTRACT
Introduction The Peripheral Primitive Neuroectodermal Tumour (pPNET)/Ewing's sarcoma family tumor (ESFT) group is a recently redefined term which includes all small round cell tumors of bone, soft tissue, and nerve with a common neuroectodermal origin. These highly aggressive pediatric soft tissue tumors occur less frequently in the craniospinal axis. Primary cranial lesion associated with spinal and pelvic metastasis is a rare presentation. Clinical Presentation A 9-year old girl was hospitalized with features of progressive increase in intracranial pressure with quadriparesis. The patient had â quadriparesis with bilateral papilledema. Brain MRI showed a large, hetero intense, contrast enhancing right parietal bony lesion infiltrating the dura with mass effect over the brain. Brain CT showed bony expansion and multiple calvarial lytic lesions. MRI cervical spine revealed collapsed fourth cervical vertebral body with extensive paravertebral and paraspinal soft tissue components with cord compression. Metastatic workup revealed a lytic lesion in the left iliac bone and left lung. The patient underwent a surgically challenging C4 corpectomy with cage fixation followed by craniotomy and excision of parietal bony lesion with titanium mesh cranioplasty in the same sitting. Histopathology revealed pPNET and was confirmed by CD99 positivity. Conclusion This rare multiple site tumor presentation was carefully planned and effectively managed by a combined single-stage surgical approach involving total excision of primary parietal bone and metastatic cervical spine tumors with primary titanium mesh cranioplasty and cervical spine stabilization, followed with radiotherapy and chemotherapy, which resulted in good recovery and improved the overall prognosis for the patient.
Introdução O grupo 'tumor neuroectodérmico primitivo periférico (pPNET) / tumor da família dos sarcomas de Ewing (ESFT)' é um termo recentemente redefinido o qual inclui todos as pequenas arredondadas células de tumor ósseo, tecidos moles e nervos com origem neuroectodérmica comum. Estes tumores pediátricos de tecido mole altamente agressivos ocorrem com menor frequência no eixo cranioespinal. Lesões primárias do crânio associadas a metástase espinhal e pélvica são raras. Relato de Caso Criança de 9 anos de idade hospitalizada com fraturas e pressão intracraniana crescente com quadriparesia. A paciente teve â de quadriparesia com papiledema bilateral. RM do cérebro por contraste mostrou uma lesão óssea parietal direita extensa e hétero-intensa infiltrando a dura-máter com efeito maciço sobre o cérebro. TC do cérebro mostrou expansão óssea e múltiplas lesões líticas na calota craniana. RM da espinha cervical revelou colapso da quarta vertebra cervical com componentes paravertebral e paraespinal de tecido mole com compressão da medula. Workup metastático revelou uma lesão lítica no ilíaco esquerdo e pulmão esquerdo. A paciente foi submetida a difícil corpectomia da C4 com fixação de cage seguida de craniotomia e excisão da lesão parietal óssea com cranioplastia com malha de titânio na mesma posição. Histopatologia revelou pPNET, confirmada por positividade de CD99. Conclusão Este raro caso com apresentação de múltiplos tumores foi cuidadosamente planejado e eficazmente conduzido por acessos cirúrgicos combinados em fase única envolvendo excisão total do osso parietal primário e tumores metastáticos da espinhal cervical com cranioplastia com malha de titânio e estabilização da espinha cervical, seguida de radioterapia e quimioterapia, resultando em boa recuperação e melhora no prognóstico geral da paciente.
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Humans , Female , Child , Sarcoma, Ewing , Neuroectodermal Tumors, Primitive, Peripheral , Spine , Neoplasm MetastasisABSTRACT
Cranioplasty is defined as the surgical repair of a cranial defect to restore the structure and function of the skull. Archaeological records show attempts of cranioplasty since the dawn of human civilization, but until today there is no consensus among neurosurgeons around the world-regarding the best material for cranioplasty. Relocation of the originally removed bone graft is still the best option, but is not always available. In modern cranioplasty, different materials can be used for the repair of cranial defects, such as metals, plastics, acrylics, and ceramics. Recent studies have sought to identify which materials provide the best long-term results, but scientific evidence is poor. Presurgical decisions must consider the experience of the surgical service and the individual conditions of the patient. In this study, we discuss the main characteristics of the materials used today for the reconstruction of cranial defects.
A cranioplastia é definida como o reparo cirúrgico de um defeito craniano, com o objetivo de restaurar a estrutura e a função do crânio. Evidências arqueológicas demonstram tentativas de cranioplastia desde os primórdios da civilização humana, porém ainda hoje não há consenso entre neurocirurgiões de todo o mundo a respeito do melhor material para a cranioplastia. Realocar o enxerto ósseo originalmente removido ainda é a melhor opção, porém nem sempre é uma possibilidade. Na cranioplastia moderna, diferentes materiais podem ser utilizados para reparar o defeito craniano, tais como metais, plásticos, acrílicos e cerâmicas. Estudos recentes vêm buscando identificar quais os materiais com melhores resultados em longo prazo; entretanto, as evidências científicas são escassas. Decisões pré-cirúrgicas devem levar em consideração a experiência do serviço cirúrgico e as condições individuais do paciente. Neste estudo discutimos as principais características dos materiais utilizados para o reparo de defeitos cranianos na atualidade.
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Humans , Skull , Surgery, Plastic , Biocompatible MaterialsABSTRACT
@# Objective To explore the related factors of common postoperative complications after cranioplasty. Methods From November, 2009 to June, 2013, a total of 211 patients after cranioplasty were reviewed. The conventional two-dimensional titanium alloy was used. The incidence of scalp effusion, seizure and spontaneous intracerebral hemorrhage were recorded, and the related factors including gender, age, primary disease, skull defect site, attack time, concomitant hydrocephalus and intraoperative dural damage were analyzed. Results The incidence of these complications was 4.7% (10/211) in total. There were four cases with scalp effusion, five cases with seizures and one case with spontaneous intracerebral hemorrhage. The scalp effusion was related to hydrocephalus (χ2=4.804, P=0.028) and intraoperative dural damage (χ2=7.510, P=0.006). Seizure and spontaneous intracerebral hemorrhage were not related with any factors above (P>0.05). Conclusion The occurrence of postoperative scalp effusion can be reduced by repairing intraoperative dural damage, and dealing with extreme hydrocephalus timely.
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Objective To evaluate changes in cerebral blood flow before and after cranioplasty by 256-slice Spiral CT perfusion imaging,and evaluate the effect of cranioplasty on the cerebral blood flow in patients with skull defect.Methods 256-slice spiral CT scan was performed in 20 cases with early cranioplasty surgery,CTP check time points were 1 to 2 days before and 10 to 14 days after cranioplasty surgery.We recorded the the CBF and CBV of the cortex,basal ganglia,and thalamus and other parts,MTT on rCBV,parameter values rCBF,MTT and 1TrP etc.and analyzed and compared.(RCBF,rCBV,MTT and TTP) Results The CBF of cortex after cranioplasty at injured side had statistically significant increase (P＜0.05).The CBF of cortex,basic nuclei,thalamus on contrateral had no statistically significant difference.The cerebral blood flow on both sides of the basal ganglia and the thalamus was increased after surgery,but there was no significant difference between before and after surgery (P＞0.05) Conclusion Cranioplasty can significantly improve the ipsilateral cortex cerebral blood flow,and CT brain perfusion can accurately assess changes in brain tissue blood flow before and after cranioplasty.
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Syndromic craniosynostosis has severe cranial stenosis and deformity, combined with hypoplastic maxillary bone and other developmental skeletal lesions. Among these various lesions, upper air way obstruction by hypoplastic maxillary bone could be the first life-threatening condition after birth. Aggressive cranial vault expansion for severely deformed cranial vaults due to multiple synostoses is necessary even in infancy, to normalize the intracranial pressure. Fronto-orbital advancement (FOA) is recommended for patients with hypoplastic anterior part of cranium induced by bicoronal and/or metopic synostoses, and posterior cranial vault expansion is recommended for those with flattening of the posterior part of the cranium by lambdoid synostosis. Although sufficient spontaneous reshaping of the cranium can be expected by expansive cranioplasty, keeping the cranial bone flap expanded sufficiently is often difficult when the initial expansion is performed during infancy. So far distraction osteogenesis (DO) is the only method to make it possible and to provide low rates of re-expansion of the cranial vault. DO is quite beneficial for both FOA and posterior cranial vault expansion, compared with the conventional methods. Associated hydrocephalus and chronic tonsillar herniation due to lambdoid synostosis can be surgically treatable. Abnormal venous drainages from the intracranial space and air way obstruction should be always considered at any surgical procedures. Neurosurgeons have to know well about the managements not only of the deformed cranial vault and the associated brain lesions but also of other multiple skeletal lesions associated with syndromic craniosynostosis, to improve treatment outcome.