Artikel
Polymethylmethacrylate patient matched implants (PMMA-PMI) for complex cranioplastic surgery
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Autoren
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Henrik Giese
- Neurochiurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Christopher Beynon
- Neurochiurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Andreas Unterberg
- Neurochiurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Cranioplasty (CP) following (decompressive) craniectomy is associated with high complication rates. This especially applies to patients with repeated surgery and postoperative complications such as wound healing disorders or bone flap necrosis. Patient matched implants (PMI) based on CT images are frequently necessary for CP. Complication rates of PMI based CP after failure of primary cranioplasty have not been reported. Here we report on our experiences with the use of polymethylmethacrylate (PMMA) PMI for cranioplastic surgery in patients with failed primary CP.
Method: We retrospectively analysed the medical records of patients with failed or complex primary CP and subsequent PMI implantation between 2010 and 2015 at our institution. PMMA-PMI were manufactured by Biomet® (Berlin, Germany). We analysed the demographic data, initial clinical diagnosis and surgery-associated complications.
Results: A total of 59 patients (27 females, 32 males) with a mean age of 44 years (range: 13 - 74 years) were included. Primary PMI-CP was performed in 17 patients with destructive or osteolytic bone tumours or discarded bone flaps. Secondary PMI-CP was performed in 42 patients. 25 patients had underone primary CP with autologous implants, which had to be removed due to bone flap necrosis (72%), wound healing disorders (12%) or bone flap infection (12%). The overall surgery-related complication rate of PMMA-PMI cranioplasty was 20% (12 patients). Complications were postoperative wound healing disorders (7%), infections (2%) and postoperative epidural or subdural hematomas (7%). Surgical explantation of the PMMA-PMI was necessary in 4 patients (7%). These data suggest that CP with PMMA-PMI has similar surgical complication rates as primary autologous CP.
Conclusions: Surgical cranioplasty with PMMA-PMI seems to represent a suitable method for patients with failed or complex cranioplasty. Despite relevant risk factors in this patient cohort, the complication rates are comparable to primary cranioplastic procedures.
