Page 213 - Clinical relevance of current materials for cranial implants
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                                 In chapter 4, a PMMA (CMW-3®) cranioplasty is described, which had been inserted in the human cranium for 15 years and had to be removed due to neurological complaints, which were most likely caused by fracture of the implant. To get more insight in material behaviors over a long period of time in the human body a gel permeation chromatography (GPC) and a micro-CT were performed and the flexural strength was measured. The fracture itself was analyzed with the use of finite element analysis (FEA). This showed that the design of the implant and the manufacture method of PMMA are important factors concerning the mechanical properties of a PMMA cranioplasty.
In Chapter 5, a two-center retrospective study is described, including 38 patients who underwent 40 patient-specific cranioplasties of PEEK. Patient and surgical characteristics, as well as associated factors for developing complications after a PEEK cranioplasty were studied. A total of 11 (27.5%) complications were observed, requiring the removal of 10 (15%) cranioplasties. Of these, 5 (12.5%) had an infection, 3 (7.5%) a hematoma, 1 (2.5%) a cerebrospinal fluid leakage and 1 (2.5%) persistent wound dehiscence. Of the 5 cranioplasties with an infection, 3 cranioplasties were again sterilized and reinserted with 100% success. No significant predictive factors were found for the failure of patient-specific cranioplasties of PEEK.
Part IV: Towards a new approach
In some patients, it is desirable to know the precise outline of the resection prior to the (decompressive) craniectomy. Therefore, resection molds and control templates may be used to improve accuracy and reduce operation time.
In chapter 6, three cases are described using a resection template and a control template for the direct insertion of a PEEK cranioplasty. The precision of the resection template was evaluated by a so-called distance map, showing that the planned cranioplasty deviated less than 1.0 mm from the actually inserted cranioplasty. After a three year follow-up there were no infections, no removed cranioplasties, no irregularities on the post-operative CT-scan, and the aesthetic outcome was satisfactory.
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Summary & Nederlandse samenvatting
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