Page 71 - Clinical relevance of current materials for cranial implants

Data collection
Clinical data were collected by reviewing the medical records of each patient by
two independent researchers (C.G. and S.V.). Extracted parameters were: location of
hospital, gender, age at the time of cranioplasty, co-morbidities (diabetes mellitus, cardiovascular disease, or both), smoking habits, initial indication for decompressive
craniectomy (cerebrovascular, trauma, neoplasm, infection), time interval between 3 decompressive craniectomy and cranioplasty, length of cranioplasty procedure
(scored from scalp incision to closure), duration of hospitalization after decompressive craniectomy and cranioplasty, failure of cranioplasty, in which year the decompressive craniectomy and cranioplasty were performed, and follow-up duration (calculated from the moment of replacement of the autologous bone flap until the last patient contact before December 2014). The neurologic status before and after cranioplasty was not specifically recorded in this study, as it was deemed to have no substantial effect on the outcome of the cranioplasty.
Recorded reasons for autologous bone flap failure included: 1) infection (defined as a clinical infection that required surgical removal), 2) resorption (defined as symptomatic or radiographic resorption where the remaining autologous bone did not protect the brain anymore or the cosmetic outcome was not acceptable), 3) subcutaneous fluid collections, and 4) hemorrhage. A procedure was classified as successful if the autologous bone flap was inserted successfully and no postoperative removal of the autologous bone flap was performed by the end of the study period, or as unsuccessful, in case of the removal of the autologous bone flap.
Defect size measuring
The CT-scans after decompressive craniectomy were retrieved and reviewed. Post- operative 3D virtual models of the CT- scans were rendered in an in-house developed software tool. This tool was developed with C++ in Microsoft Visual Studio 2015 (Microsoft Corporation, Redmond, WA, USA). After reconstructing the 3D-models, landmarks were manually placed on the border of the defect to measure the circumference of the defect (Figure 1).
Autologous cranioplasty
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