Article
Cranioplasty for large skull defects with PMMA (Polymethylmetacrylate) or Tutoplast processed autologous bone-grafts
Kranioplastie bei großen Kalottendefekten mit PMMA (Polymethylmethacrylat) oder aufgearbeitetem autogenen Knochen nach dem Tutoplast Verfahren
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Authors
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H. Clusmann
- Neurochirurgische Universitätsklinik, Bonn
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R. Kriegel
- Neurochirurgische Universitätsklinik, Bonn
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C. Schaller
- Neurochirurgische Universitätsklinik, Bonn
| Published: | May 4, 2005 |
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Outline
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Objective
Plastic reconstruction of large skull defects is challenging, titanium implants are expensive (ca. 5000€). Cosmetic results with PMMA (ca. 80-160€) are unreliable, and reimplantation of frozen bone (0€) can lead to infectious problems and resorption. In this study Tutoplast processed autografts (ca. 400€) are compared to conventional PMMA cranioplasty.
Methods
Retrospective analysis in a consecutive series of 61 plastic reconstructions for skull defects measuring more than 12 cm in diameter, performed between 1993 – 2003. Cranioplasty was either done with PMMA or with the patients own boneflap, which had been recycled by the Tutoplast-process: thereby all biologic material is eliminated, except for retaining the collagene and mineral matrix, and thus the shape.
Results
36 patients underwent freehand PMMA cranioplasty. Mean age was 44 years. Reason for craniectomy was decompression (19 patients), infection (15 patients), and bone destruction (2 patients). Bilateral procedures were done in 10 patients. Mean operating time was 142±39 minutes. Mean follow-up was 44 months. 4 patients died, 14 remained severely disabled, 18 had a worthwhile recovery. 2 patients had PMMA related complications and required removal (5.6%). 26 patients exhibited at least satisfactory cosmetic results (72%), in 5 patients results were not satisfactory (14%), 5 unknown (14%). 25 patients received Tutoplast processed autografts. Mean age was 42 years. Reason for craniectomy was decompression in all cases. Bilateral procedures were done in 3 patients. Mean operating time was 108±41 minutes. Mean follow-up was 15 months. 1 patient died, 18 remained severely disabled, 6 had a worthwhile recovery. All patients had satisfactory cosmetic results, but 2 patients required removal later, one due to infection (4%), one for bone resorption (4%). Of 18 patients with follow-up >1 year significant resorption occurred in all 5 children and adolescents and in 1 adult patient.
Conclusions
Cosmetic results were better with Tutoplast processed autografts, and operating time was shorter. Complication rates were similar. Resorption occurred in all children and adolescents, but was rare in adults. Thus, Tutoplast processed boneflaps can be a reasonable alternative to other methods of cranioplasty, especially in adult patients with large craniotomy defects.
