Patient-specific implants compared with stored bone grafts for patients with interval cranioplasty.

Interval cranioplasty after craniectomy carries the risk of infection and failure. There is no consensus regarding the choice of reconstruction technique. In addition to the replacement of the stored autogenous bone graft, the use of patient-specific implants (PSIs) has become popular. We conducted a retrospective study comparing 17 patients who underwent reconstruction with PSIs (titanium and polyether ether ketone) (follow-up, 43 months [range, 3-93]) with 16 control subjects who had their stored bone grafts reimplanted (follow-up, 32 months [range, 5-92]) based on success rate, complication rate, operative time, and duration of hospitalization. Complication rate and the rate of necessary reoperation were significantly lower, and the hospital stay was shorter in the PSI group. We did not find any significant differences concerning operative time. In our patient groups, interval reconstruction after craniectomy with a PSI was a safer procedure based on complication and success rates than reconstruction with stored autogenous bone grafts. In patients with interval cranioplasty who have a higher risk for complication or failure, the use of PSIs should be the treatment of choice.

A treatment algorithm for patients with large skull bone defects and first results.

Large skull bone defects resulting from craniotomies due to cerebral insults, trauma or tumours create functional and aesthetic disturbances to the patient. The reconstruction of large osseous defects is still challenging. A treatment algorithm is presented based on the close interaction of radiologists, computer engineers and cranio-maxillofacial surgeons. From 2004 until today twelve consecutive patients have been operated on successfully according to this treatment plan. Titanium and polyetheretherketone (PEEK) were used to manufacture the implants. The treatment algorithm is proved to be reliable. No corrections had to be performed either to the skull bone or to the implant. Short operations and hospitalization periods are essential prerequisites for treatment success and justify the high expenses.