Page 211 - Clinical relevance of current materials for cranial implants

SUMMARY
Part I: Introduction
The brain is one of the most important organs of the human body. It ensures that human beings can perform conscious actions and movements, and to have thoughts and emotions. The skull (i.e. the neurocranium) protects the brain from external impact, atmospheric pressure and harbor sensory organs.
In Chapter 1 the consequences of skull pathology are outlined. Due to a trauma, cerebrovascular event, infection or neoplasm, intracranial pressure may increase, which leads to a life-threatening condition. To reduce the intracranial pressure, a decompressive craniectomy can be performed, in which part of the skull is removed. Typically, the removed skull bone flap is reinserted during the same surgical procedure as an immediate autologous reconstruction. In exceptional cases, for example if the brain is too swollen, blood coagulation is disturbed, or the patient is neurologically unstable, the neurosurgeon may decide not to reinsert the autologous bone flap. In these cases, the removed bone is stored in a freezer with an average temperature of -80 °C, or in an abdominal pocket of the patient. If the patient is neurologically stable and his general condition is satisfactory, the autologous bone is reinserted in a second surgical intervention. This reconstruction is also known as a cranioplasty. In some cases it is not possible to replace the autologous bone, for example if it has been lost due to fragmentation, if there is an infection, or if there is no bone bank available for cryopreservation. In these cases the use of an alloplastic material is an alternative solution. Many different materials have been developed and are used daily for cranioplasty. The materials principally mentioned in literature are autologous bone, titanium, poly(methyl metacrylate) (PMMA), hydroxyapatite and poly (ether ether ketone).
The principal outline of this thesis was to investigate and understand the clinical issues of different materials used for cranioplasty. If we can grasp the clinical problems related to the current materials used for cranioplasties, an even more advanced material might be developed to reduce intra-operative and clinical complications.
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Summary & Nederlandse samenvatting
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