Page 15 - Clinical relevance of current materials for cranial implants

General introduction and outline of this thesis
GENERAL INTRODUCTION 1
The skull consists of the neurocranium and viscerocranium, it protects the brain, the source of cognition, logical thinking, imagination, creativity, emotion and memory. Protection of the brain by the skull is essential to the living human.
Decompressive craniectomy and cranioplasty
Decompressive craniotomy or craniectomy is a life-saving neurosurgical procedure in which part of the cranium is removed to reduce raised intracranial pressure (Figure 1A + 1B). This may result from, for example, cerebral edema or hemorrhage due to traumatic brain injury, cerebral infarction, subarachnoid hemorrhage, hemorrhagic strokes, neoplasms, or intracranial infections1–5.
Figure 1: A) Intact cranium B) Cranium after decompressive craniectomy C) Cranium with a cranioplasty in situ
During a decompressive craniotomy the removed part of the skull is replaced back into the cranium during the same surgical procedure as the removal of the autologous bone6. In some circumstances, this is not possible because of edema of the brain or persistently increased intra-cranial pressure. In such cases the removed part of the skull may be preserved and stored in a bone bank at temperatures as low as -84 °C7,8 or stored in a surgically created abdominal subcutaneous pocket in the patient8–11. The autologous bone can be re-inserted when the patient has recuperated from the acute phase of illness and is neurologically stable5. This procedure has the definition decompressive craniectomy.
13