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cranioplasty_materials

Cranioplasty materials

Available evidence on the safety of cranioplasty materials is limited due to a large diversity in study conduct, patients included and outcomes reported. Autologous bone grafts appear to carry a higher failure risk than allografts. Future publications concerning cranioplasties will benefit by a standardized reporting of surgical procedures, outcomes and graft materials used 1).

A literature review in 2016 emphasizes the benefits and weaknesses of each considered material commonly used for cranioplasty, especially in terms of infectious complications, fractures, and morphological outcomes.As regards the latter, this appears to be very similar among the different materials when custom three-dimensional modeling is used for implant development, suggesting that this criterion is strongly influenced by implant design. However, the overall infection rate can vary from 0% to 30%, apparently dependent on the type of material used, likely in virtue of the wide variation in their chemico-physical composition. Among the different materials used for cranioplasty implants, synthetics such as polyetheretherketone, polymethylmethacrylate, and titanium show a higher primary tear resistance, whereas hydroxyapatite and autologous bone display good biomimetic properties, although the latter has been ascribed a variable reabsorption rate of between 3% and 50%. In short, all cranioplasty procedures and materials have their advantages and disadvantages, and none of the currently available materials meet the criteria required for an ideal implant. Hence, the choice of cranioplasty materials is still essentially reliant on the surgeon's preference 2).


In 19th century, the use of bone from different donor sites, such as ribs or tibia, gained wide population.

Many different types of materials were used throughout the history of cranioplasty. With the evolving biomedical technology, new materials are available to be used by the surgeons. Although many different materials and techniques had been described, there is still no consensus about the best material, and ongoing researches on both biologic and nonbiologic substitutions continue aiming to develop the ideal reconstruction materials.

Cranioplasty can be performed either with gold-standard, autologous bone flaps and osteotomies or alloplastic materials in skeletally mature patients. Recently, custom computer-generated implants (CCGIs) have gained popularity with surgeons because of potential advantages, which include preoperatively planned contour, obviated donor-site morbidity, and operative time savings. A remaining concern is the cost of CCGI production.

see Autologous bone flap cranioplasty

Synthetic implants

Several materials are available. Each has its advantages and disadvantages. Search is on for an ideal material.

Polymethylmethacrylate cranioplasty and polyetheretherketone (PEEK) are the most commonly applied today.

Celluloid cranioplasty

PEEK cranioplasty

Fiberglass cranioplasty

Polypropylene polyester knitwear

Tantalum cranioplasty

Titanium cranioplasty

Acrylic bone cement


An experimental model was developed in an indoor gun range. CAD cranioplasties with a material thickness of 2-6 mm, made of titanium or PEEK-OPTIMA(®) were fixed in a watermelon and shot at with a .222 Remington rifle at a distance of 30 m distance, a .30-06 Springfield rifle at a distance of 30 m, a Luger 9 mm pistol at a distance of 8 m, or a .375 Magnum revolver at a distance of 8 m. The CAD cranioplasties were subsequently inspected for ballistic effects by a neurosurgeon.

Titanium CAD cranioplasty implants resisted shots from the 9 mm Luger pistol and were penetrated by both the .222 Remington and the .30-06 Springfield rifle. Shooting with the .357 Magnum revolver resulted in the titanium implant bursting. PEEK-OPTIMA(®) implants did not resist bullets shot from any weapon. The implants burst on shooting with the 9 mm Luger pistol, the .222 Remington, the .30-06 Springfield rifle, and the .357 Magnum revolver.

Titanium CAD cranioplasty implants may offer protection from ballistic injuries caused by small caliber weapons fired at short distances. This could provide a life-saving advantage in civilian as well as military combat situations 3).


Methylmethacrylate and porous polyethylene (PP) were resistant to fracture and disruption. MMA provided the greatest neuroprotection, followed by PP. Autologous bone provided the least protection with cranioplasty disruption and severe brain injury occurring in every patient. Brain injury patterns correlated with the degree of cranioplasty disruption regardless of the cranioplasty material. Regardless of the energy of impact, lack of dislodgement generally resulted in no obvious brain injury 4).

Sonolucent cranioplasty

References

1)
van de Vijfeijken SECM, Münker TJAG, Spijker R, Karssemakers LHE, Vandertop WP, Becking AG, Ubbink DT; CranioSafe Group. Autologous bone is inferior to alloplastic cranioplasties Safety of autograft and allograft materials for cranioplasties, a systematic review. World Neurosurg. 2018 Jun 4. pii: S1878-8750(18)31147-1. doi: 10.1016/j.wneu.2018.05.193. [Epub ahead of print] Review. PubMed PMID: 29879511.
2)
Zanotti B, Zingaretti N, Verlicchi A, Robiony M, Alfieri A, Parodi PC. Cranioplasty: Review of Materials. J Craniofac Surg. 2016 Aug 19. [Epub ahead of print] PubMed PMID: 27548829.
3)
Lemcke J, Löser R, Telm A, Meier U. Ballistics for neurosurgeons: Effects of firearms of customized cranioplasty implants. Surg Neurol Int. 2013 Apr 3;4:46. doi: 10.4103/2152-7806.110027. Print 2013. PubMed PMID: 23607068; PubMed Central PMCID: PMC3622352.
4)
Wallace RD, Salt C, Konofaos P. Comparison of Autogenous and Alloplastic Cranioplasty Materials Following Impact Testing. J Craniofac Surg. 2015 Jul;26(5):1551-7. doi: 10.1097/SCS.0000000000001882. PubMed PMID: 26114508.
cranioplasty_materials.txt · Last modified: 2019/04/03 17:26 by administrador