Page 39 - Clinical relevance of current materials for cranial implants

Autologous bone is inferior to alloplastic cranioplasties
Of 228 included articles, 118 (51.8%) reported on esthetic outcome after cranioplasty.
Eighteen were assessed using a grading system, of which 10 used a custom-made questionnaire including a grading system43-52, 3 studies used the Visual Analog 2 Cosmesis Scale53-55, 2 the cranial index of symmetry26,27, and 2 the Odom criteria56,57.
Rotaru et al. used a 3D-reconstructed CT examination to determine esthetic outcome20.
In 70 (30.7%) studies an esthetic outcome was mentioned but was subjective as no
further measure of evaluation was reported. Thirty-five articles reported esthetic
outcome as defined by the patient, 5 as reported by relatives, whereas 14 were assessed
by the clinician, and 14 were based on the CT results, of which only 3 were objectively
graded. Twelve of these reported on the esthetic outcome as judged by both the
patient and the clinician.
Five (2.2%) articles reported QoL after cranioplasty12,46,52,55,58. Manrique et al. and Lindner et al. used the specific University of Washington Quality of Life scale and the generic short-form-36 scale, respectively12,58.
Characteristics of included patients
Indications for a cranioplasty were listed in 209 studies, consisting mostly of trauma (n=3352), cerebrovascular (n=2100), tumor (n=1365), or infection (n=222) (Table 1). Two thousand seven hundred twenty patients underwent unilateral, 101 patients bilateral, and 211 patients bifrontal cranioplasties. The affected cranial bone was mentioned in 116 studies (50.9%). The surface area of the defect was mentioned in 110 studies with a mean of 82.6 cm2 and ranging between 1.5 cm2 and 517.4 cm2. Based on available data from 184 studies comprising 6917 patients, 4191 (60.6%) of them were male. In 200 (87.7%) studies the age was reported and ranged from 0 to 90 years, the mean age was 36.0 years old. Comorbidities were reported in 32 (14.0%) studies. Ten studies mentioned smoking habits.
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