Reconstructive Surgery of Posttraumatic Cranial Defects and Deformities: Search for Optimum Materials and Technologies of Implant Manufacture

Kravchuk .*, Potapov .*, Kornienko V.*, Panchenko V.**, Evseev .**, Shurhay V.***, Bittirov .*

* Burdenko Research Institute of Neurosurgery, Moscow, Russia;
** Institute of Laser Technologies of the Russian Academy of Sciences, Moscow, Russia;
*** Sechenov Moscow Medical Academy, Moscow, Russia

 

The research goal was studying a rate of complications in use of different materials and technologies of implant manufacture in reconstructive surgery of posttraumatic cranial defects.

Material and Methods. The research was carried out on 1122 cases with posttraumatic cranial defects, operated in 1984-2005. Their age varied from 4 up to 77 years (25.6±13.5). Reconstructive operations were performed 20.6±0.2 months after trauma. Severe, moderate and minor craniocerebral trauma was watched in 784, 169 and 29 cases respectively. There were 636 patients with good restoration by the moment of operation; 289 and 76 cases had moderate and severe disability respectively. Preoperative CT-examination was carried out in all the patients; in case of complex defects we used 3-D CT. Application of stereo-lithographic creation of skull models and press moulds for implant manufacture started in 2000. During the above period cranioplasty was performed with consecutive use of the following materials: formalinized bone (84), lyophilized bone (71), protacryl (250), biopolymer or BOP (29), codubix (68), autobone (70), palakos+rifampicin (437).

Results. The highest rate of pyo-inflammatory complications was watched in use of lyophilized bone (12.7%), BOP (11.5%), protacryl (5.6%), codubix (3%), formalinized bone (2.4%). As for palakos, this index was 0.7%. There were no inflammatory complications in autobone application; however, partial or complete resorption of an implant was present in 27% of cases (if a defect was more than 30 cm2).

Conclusions. Use of 3-D CT, stereo-lithographic creation of skull models and implants improves quality of reconstructive operations. A rate of inflammatory complications is minimum in palakos application. Autobone is an optimum material for cranioplasty of small defects.