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cranioplasty

Cranioplasty

Cranioplasty is a surgical intervention to repair cranial defects, frequently performed in neurosurgery.

It is one of the oldest known neurosurgical procedures, dating from the year 3000 B. C., when the Paracas Indians in Peru performed procedures to correct large cranial defects.

Archeologic findings proved that the use of inorganic materials for cranioplasty had begun before the organic materials 1).

Across the centuries, many materials have been used for covering bony defects, including coconut shells, bones from both human and non-human donors, metals including gold, silver, tantalum, and titanium and more recently, biosynthetic materials such as resins and ceramics.

Indications

Contraindications

The presence of hydrocephalus, infection, and brain swelling. In children below 4 years old, if there is an intact dura mater, cranium can achieve self closure.

Timing

Classification

see Custom made cranioplasty.


The pediatric patient for this procedure is distinct from the adult one because of the growing skulls and thinner bones of the calvarium. A paucity of data on the outcomes of this procedure in the pediatric population has been identified repeatedly.

Wagas et al conducted a retrospective cohort study to investigate the outcomes in a pediatric population that underwent cranioplasty after craniectomy at a institute in a developing-world country. The cohort showed no association of complication rate or cosmetic outcomes with the timing of cranioplasty, area of skull defect, type of implant used, or method of storage 2).

Cranioplasty Materials

Complications

Review

2017

A PubMed, Google Scholar, and MEDLINE search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines included studies reporting patients who underwent DC and subsequent cranioplasty in whom cerebral hemodynamics were measured before and after cranioplasty.

The search yielded 21 articles with a total of 205 patients (range 3-76 years) who underwent DC and subsequent cranioplasty. Two studies enrolled 29 control subjects for a total of 234 subjects. Studies used different imaging modalities, including CT perfusion (n = 10), Xenon-CT (n = 3), single-photon emission CT (n = 2), transcranial Doppler (n = 6), MR perfusion (n = 1), and positron emission tomography (n = 2). Precranioplasty CBF evaluation ranged from 2 days to 6 months; postcranioplasty CBF evaluation ranged from 7 days to 6 months. All studies demonstrated an increase in CBF ipsilateral to the side of the cranioplasty. Nine of 21 studies also reported an increase in CBF on the contralateral side. Neurological function improved in an overwhelming majority of patients after cranioplasty.

This systematic review suggests that cranioplasty improves CBF following DC with a concurrent improvement in neurological function. The causative impact of CBF on neurological function, however, requires further study 3).

Case series

Cranioplasty surgical technique

1)
Sanan A, Haines SJ. Repairing holes in the head: A history of cranioplasty. Neurosurgery. 1997;40:588–603.
2)
Waqas M, Ujjan B, Hadi YB, Najmuddin F, Laghari AA, Khalid S, Bari ME, Bhatti UF. Cranioplasty after Craniectomy in a Pediatric Population: Single-Center Experience from a Developing Country. Pediatr Neurosurg. 2016 Dec 8. [Epub ahead of print] PubMed PMID: 27926912.
3)
Halani SH, Chu JK, Malcolm JG, Rindler RS, Allen JW, Grossberg JA, Pradilla G, Ahmad FU. Effects of Cranioplasty on Cerebral Blood Flow Following Decompressive Craniectomy: A Systematic Review of the Literature. Neurosurgery. 2017 Mar 29. doi: 10.1093/neuros/nyx054. [Epub ahead of print] PubMed PMID: 28368505.
cranioplasty.txt · Last modified: 2019/10/12 12:54 by administrador