Page 69 - Clinical relevance of current materials for cranial implants

INTRODUCTION
Decompressive craniectomy is a lifesaving neurosurgical procedure, in which a part
of the skull is removed to reduce raised intracranial pressure, resulting from cerebral
edema or hemorrhage due to traumatic brain injury, cerebral infarction, subarachnoid hemorrhage, hemorrhagic strokes, neoplasm, or intracranial infections.1–4 Following 3 decompressive craniectomy, reconstruction of the cranial defect is mandatory in order
to protect the brain, enhance social acceptance, and restore cranial esthetics. Moreover, it may reduce neurologic symptoms, including the syndrome of the trephined and sinking skin flap syndrome. 2,4–12
Autologous bone can be used for cranial reconstructions as it is biocompatible, inexpensive, does not trigger immuno-rejection11, and can be effective as a substrate for bony ingrowth and revascularization13–15. In delayed cranial reconstructions, the autologous bone flap is usually stored in a bone bank and re-inserted when the patient is neurologically stable. Storage techniques may significantly alter bone viability; storage temperatures between 8 oC and -84 oC have been reported.6,11,15–20 There is no consensus on the optimal time interval between decompressive craniectomy and cranioplasty; different wide-ranging thresholds have been used in the literature9,21–26.
Reimplantation of preserved autologous bone has a high risk of infection (0%-26%) 2,11,18,19,27–30 and bone flap resorption (1%-50%),4,6,12,13,16,22,27,30 often resulting in loss of the autologous bone flap.31
The aim of this study was to determine independent predictive factors for the failure of autologous bone flaps used for cranioplasty in patients who had undergone decompressive craniectomy.
Autologous cranioplasty
67