Page 80 - Clinical relevance of current materials for cranial implants

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Chapter 3
Fourth, this study only included autologous bone that was stored in the freezer at -80oC. However, other options for bone storage are mentioned in the literature. Corliss showed no significant differences between cryopreservation and storage in an abdominal pocket for resorption (9.7 vs 7.7), infection (7.3 vs 7.1) or reoperations (15.9 vs 7.6)44. Another study showed a resorption rate of 20% after bone flap sterilization and storage in a refrigerator at 8oC6. Nowadays, numerous alloplastic materials have been developed for cranioplasties, each with their own benefits and potential harms. The most frequently reported materials are poly(methyl methacrylate) (PMMA), poly (ether ether ketone) (PEEK), titanium, hydroxyapatite. However, there is still no consensus on the optimal material for cranial reconstruction31.
CONCLUSION
The risk of autologous bone flap failure in patients who underwent decompressive craniectomy is considerable, especially in those operated for a neoplasm. Patients with a longer hospitalization time after decompressive craniectomy may benefit from an early recovery program after surgery to eventually reduce failure of the cranioplasty, or by the use of an alloplastic material for cranial reconstruction. This also holds for patients with a large cranial defect and those with a longer life expectancy. There is still no consensus about the time interval between decompressive craniectomy and cranioplasty. A randomized trial could help make an evidence-based decision when to proceed with the cranioplasty. Finally a standard follow-up protocol may improve early detection and reduce the risk of failure of an autologous bone flap.