Aurel MOHAN

Abstract

THE BENEFITS OF CUSTOMIZED CRANIOPLASTY IN DECOMPRESSIVE CRANIECTOMIES AFTER SEVERE BRAIN INJURIES.

Ghiurău N. Adrian¹, Mohan G. Aurel¹, Vlad Silviu Valentin¹, Antoniac V. Iulian².

¹⁾Faculty of Medicine and Pharmacy, University of Oradea, Faculty of Medicine and Pharmacy, Department of Surgical Disciplines, Romania,

²⁾University Politehnica of Bucharest, Faculty of Material Science and Engineering, Department of Materials Science and Physical Metallurgy, Bucharest, Romania.

E-mail: ^a)ghiurau.adrian@yahoo.com / Tel.: 0040743952768

Keywords: Cranioplasty, TBI, PEEK, PMMA, Implants, Biomaterials.

Background.

Cranioplasty is the surgical repair of a bone defect in the skull resulting from a injury or a previous operation, such as decompressive craniectomy. The loss of cranial bone integrity due to a trauma or injury of the head is a contemporary example of tissue failure, which usually requires the permanent or temporary implantation of a bone substituent and may become challenging in case of large defects. The implications of cranioplasty are: psychological, aesthetic and functional. Our paper presents the implications and the benefits of customized cranioplasty for patients with severe traumatic brain injury (TBI), using different types of materials such as titanium mesh, acrylic implants (PMMA) and polyetheretherketone (PEEK) implants and others.

Aim of the study.

The aim of this study is to report the implications and benefits in using the different types of implants (Titanium mesh, PMMA and PEEK) used in cranioplasty after traumatic brain injury.

Matherials and methods.

Throughout the history many types of materials were used in performing a cranioplasty. With the biomedical technology evolving, new materials are now available to be used by the neurosurgeons. The implant allows the replacement of the bone gaps of the patient's cranial skeleton. The implant is modeled and sized to fit the individual anatomy of each patient. The implant is designed with a software, after receiving the patient's CT scan and made of polyetheretherketone (PEEK) or polymethyl methacrylate (PMMA), being supplied as a single component or as multiple components. The implant is attached to the native bone with self-locking plates or fixed using standard cranial fixation systems or using standard titanium screws.

The most commonly used materials in cranioplasty are: polymethylmethacrylate (PMMA) and polyetheretherketone (PEEK) most commonly used today, titanium plates, fiberglass boards, polypropylene boards, acrylic bone cement, other materia

We reviewed a number of 32 cases which were subjected to cranial reconstruction following traumatic brain injury. A total of 14 patients, 9 males and 5 females, aged between 23 and 55 years, underwent elective delayed cranioplasty surgery with PEEK implants, 8 patients, 6 males and 2 females received PMMA implants and 10 patients, 7 males and 3 females with titanium mesh, all to achieve morphological and functional rehabilitation of the cranial vault performed during the period from 1^st January 2018 to 31^st December 2023. All surgeries were performed in accordance with the widely-accepted indications for cranioplasty. During the study we followed also the recovery period for the patients involved, and also the social reintegration through the follow-ups, with excellent results from this point of view in most of the cases.

Results.

Benefits of using these types of materials are: the short period of time in the hospital for the patient, minimal postoperative residual pain, complete reconstruction of the bone defect, excellent results in terms of recovery, patients less affected from a psychological point of view.

Biomaterials implants are a safe and time effective way to reconstruct cranial defects following severe traumatic brain injury (TBI). Among the advantages of these materials, such as PMMA and polyetheretherketone implants (PEEK), is their‘s nonferromagnetic capacity which permits the safe examination in magnetic resonance imaging high field, useful for long-term follow-up. Prefabricated implants were very effective for cranioplasty, reducing surgical time, surgical blood loss and technical simplicity. 

Conclusions.

Biomaterials represent a tremendous leap forward in the surgical management of skull deformities. Biomaterials implants are extremly effective for cranioplasty. These implants also contribute in a special way to the social reintegration of these patients, the psychological component having an essential role in their recovery and for the social reintegration. The materials and techniques used in cranioplasty are in a continuous development and evolution.