Document Detail


Cranioplasty for large skull defects with PMMA (Polymethylmethacrylate) or Tutoplast processed autogenic bone grafts.
MedLine Citation:
PMID:  17966077     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Aim of the study was a comparison of cranioplasty using the Tutoplast technology for autogenic bone processing and conventional polymethylmethacrylate (PMMA) calvarial re- construction. PATIENTS AND METHODS: A retrospective analysis was carried out in a consecutive series of 61 plastic reconstructions for skull defects, the largest measuring more than 12 cm. Cranioplasty was either performed with PMMA or with the patient's own bone graft which had been recycled using the Tutoplast process. RESULTS: 36 patients with a mean age of 44 (range 10-68) years underwent freehand PMMA cranioplasty following craniectomy for increased intracranial pressure (19 patients, 52.8%), infection (15 patients, 41.7%), or traumatic bone destruction (2 patients, 5.6%). Bilateral procedures were performed in 10 patients (27.8%). Mean follow-up was 44 months. Four patients (11.1%) died, 14 (38.9%) remained severely disabled, and 18 (50%) made a satisfactory recovery. Two patients (5.6%) had PMMA-related complications and required removal. 26 patients exhibited at least satisfactory cosmetic results (83.9%), in 5 patients the results were not satisfactory (16.1%) and in 5 the results are unknown. Twenty-five patients with a mean age of 42 (range 2-68) years received Tutoplast processed autografts following craniectomy for elevated intracranial pressure. Bilateral procedures were performed in 3 patients (12%). Mean follow-up was 15 months. One patient (4%) died, 18 (72%) remained severely disabled, and 6 (24%) made a satisfactory recovery. All patients had satisfactory cosmetic results, but 2 patients (8.3%) required removal at a later stage, one due to infection (4.2%) and one for bone resorption (4.2%). In the 18 patients with follow-up >0.5 years significant resorption occurred in all 5 children and adolescents (100%) and in two adult patients (15.4%). CONCLUSION: Cosmetic results were more satisfactory with Tutoplast processed autografts, and the operating time for unilateral surgery was shorter. Complication rates were similar. Resorption occurred in all children and adolescents, but was rare in adults. Thus, Tutoplast processed autogenic bone grafts can be a reasonable alternative to other methods of cranioplasty in adult patients with large craniotomy defects. Cranioplasty in children and adolescents remains an unsolved problem.
Authors:
R J Kriegel; C Schaller; H Clusmann
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2007-10-26
Journal Detail:
Title:  Zentralblatt für Neurochirurgie     Volume:  68     ISSN:  0044-4251     ISO Abbreviation:  Zentralbl. Neurochir.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-28     Completed Date:  2008-02-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0413646     Medline TA:  Zentralbl Neurochir     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  182-9     Citation Subset:  IM    
Affiliation:
Neurochirurgische Klinik, Universitätsklinikum Bonn, Bonn, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Bone Resorption / epidemiology
Bone Substitutes*
Bone Transplantation*
Child
Child, Preschool
Decompression, Surgical
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neurosurgical Procedures*
Polymethyl Methacrylate*
Postoperative Complications / epidemiology
Retrospective Studies
Skull / abnormalities*,  surgery*
Tomography, X-Ray Computed
Transplantation, Autologous
Treatment Outcome
Chemical
Reg. No./Substance:
0/Bone Substitutes; 9011-14-7/Polymethyl Methacrylate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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