Treatment of Cases with Defects of the Skull Bones: The Rate of Postoperative Complications and Its Dependence on Materials Used for Cranioplasty

S.V. Marchenko, A.M. Vasilyev, M.O. Danilevich, N.N. Sereda, T.N. Kanaan, A.V. Kudlachev

(Municipal Aleksandrovskaya Hospital N 17, Saint Petersburg)

The rate of craniocerebral trauma varies from 1.8% up to 5.4 % of cases per 1000 men. According to the WHO data, it tends to grow by 2% per a year. In its turn, this leads to a greater need of surgical interventions, which end in external decompression with removal of a bone flap (or bone fragments) in approximately a half of cases. Thus, plasty of bone defects is a necessary surgical intervention and the last stage of craniocerebral trauma treatment. Today defects of the skull bones are closed with high-molecular polymeric materials (protacryl, butacryl and their foreign radiopaque analogues); an autobone, preserved or kept within tissues of a patient; a cadaverous bone and metal implants.

Comparative analysis of the rate of complications, observed in early and remote postoperative periods and depending on use of different materials for closure of bone defects of the skull, was carried out.

The study includes 176 cases, treated in the neurosurgical department of the Aleksandrovskaya hospital N 2 in 1998-2006. Plasty of the above defects was performed during a period, varying from 2 weeks up to 9 years since the moment of decompression trephination. It was done with applying a titanium net (98 cases), an autobone (62) and protacryl (16). While analyzing the data, we took into account a number of inflammatory complications; results of EEG, ultrasonic examination and thermography; dynamics of neurological complications. Use of a titanium net resulted in inflammatory complications in 2 cases (2%), manifesting themselves in suppurated ligatures with fistulas formation. They were taken out and the wound healed by first intention without removal of a titanium implant. Plasty with an autobone led to complications, demanding a transplant removal in 7 (11.3%) cases (purulent fistulas with osteomyelitis 3, lysis of a bone transplant - 4). Aseptic inflammation with fistulas formation and an implant destruction due to repeated trauma were watched in 2 (12.5%) and 3 (18.7%) cases with plasty by protacryl respectively. The comparison of results of EEG, ultrasonic examination and thermography, obtained in applying different materials for closure of the skull bone defects, demonstrated preference of a titanium net.