Page 23 - Clinical relevance of current materials for cranial implants

General introduction and outline of this thesis
AIMS AND OUTLINE OF THIS THESIS 1
This thesis is subdivided into four main parts, covering several aspects of the current materials for cranioplasties and the development and techniques of future methods and materials for cranioplasties: current evidence, current challenges, towards a new approach and toward the ideal material. This is followed by a general discussion of the contents of this thesis and future perspectives in this field.
Part II: Current evidence
The management of decompressive craniectomy and cranioplasty varies greatly between countries, hospitals and neurosurgeons. Regulations, e.g. national guidelines for bone banks and the recent European MDR (medical devices regulations) and costs with or without reimbursements from the government have a tremendous influence on the possibilities and choices for various techniques and materials. Many different materials have been developed and are being used in daily practice. In Chapter 2 all available evidence is summarized in patients who underwent cranioplasty using either autologous bone or alloplastic materials.
The principal outline of this thesis is to investigate and understand the clinical issues of different materials used for cranioplasties. If the individual factors can be identified that influence the clinical problems related to the current materials used for cranioplasties, more advanced materials may even be developed to reduce intra- operative and clinical complications.
Part III: Current challenges
The reasons for failure of existing materials for cranioplasty is important for the development of new materials. If the shortcomings are known, they may be camouflaged or even avoided. In part III of this thesis, different materials used for cranioplasties in clinical settings are explicated, in order to assess the advantages and disadvantages of the various materials.
After a decompressive craniectomy, a cranioplasty is mandatory to protect the brain and restore cranial esthetics. Autologous bone may be used for cranial reconstructions. However, reimplantation of preserved autologous bone is known to have a substantial risk of infection and bone flap resorption, not seldom resulting in loss of the autologous bone flap. In order to identify and quantify the risks of failure of autologous bone flaps, a two-center retrospective study is performed (Chapter 3).
21