Page 34 - Clinical relevance of current materials for cranial implants

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Chapter 2
Many studies have been published regarding the possible benefits and potential risks or risk factors of complications after cranioplasty. However, no all-encompassing review has been published to this date. This comprehensive review summarizes all available evidence in patients who underwent cranioplasty using either autologous bone or alloplastic materials regarding their safety, to aid evidence-based decision- making.
MATERIAL AND METHODS
Search strategy
This systematic review was conducted using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, methodological standards outlined in the Cochrane Handbook for Systematic Reviewers and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria (Figure 1)15,16. A systematic search of the literature was conducted in MEDLINE, EMBASE and the Cochrane library from their inception until January 26, 2017. Search terms included MeSH-terms in PubMed and EMtree, as well as free text terms. For the Cochrane library free text terms were used. The full search strategies for each database are shown in Supplementary Table 1.
Selection process
Two reviewers (S.V. and T.M.) independently screened all potentially relevant titles and abstracts for eligibility. If necessary, the full text article was checked for the eligibility criteria. Articles were included if they met the following criteria: 1) clinical patient study; 2) a cranioplasty was performed or; 3) a craniectomy in combination with cranioplasty or; 4) a craniotomy with alloplastic material for any patient and any indication and; 5) were written in, or translated to, a Western European language.
Studies were excluded if: 1) the surgical intervention was a craniotomy with simultaneous replacement of the autologous bone graft; 2) non-clinical articles (technical notes, animal studies, laboratory studies, letters, systematic reviews); 3) 6 or more materials were used; or 4) primary outcomes were not reported per material. Disagreements were resolved by consensus or discussed with a third reviewer (D.U.). After the first selection the full text of the articles was obtained for further review.