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Clinical aspects of head injury
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Reconstructive surgery may be indicated, to make good a skull vault defect created by earlier, emergency removal of a calvarial bone flap. Normally, an interval of 3 to 6 months is allowed to pass, during which time ICPs settle, inflammation subsides and a neo-dura forms between the brain and the overlying scalp. Thereafter, a cranioplasty can be performed, either by replacing the bone flap that was removed during the emergency decompression5 or by inserting a prosthetic substitute such as titanium. Smaller defects can be filled with acrylic cement. The commonest complication is that of chronic wound infection (Acciarri et al. 2016) but benefits include cosmesis and the provision of protection for the underlying brain. Another argument in favour of restoring the skull vault is that, by allowing the brainstem to adopt a less distorted position inside the head, the reticular activating system becomes more active. A dependent patient may then become more responsive and, at the very least, somewhat easier to nurse.
Posterior Skull Surgery in Craniosynostosis
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
Procedures for expansion of the posterior cranial vault were developed to increase intracranial volume, address intracranial hypertension, and redirect cerebral expansion posteriorly. Initial techniques entailed formal cranioplasty with fixation of bone segments.3,4,5
Composite Materials for Oral and Craniofacial Repair or Regeneration
Published in Vincenzo Guarino, Marco Antonio Alvarez-Pérez, Current Advances in Oral and Craniofacial Tissue Engineering, 2020
Teresa Russo, Roberto De Santis, Antonio Gloria
Cranioplasty is a common procedure for correcting bone defects or deformities in the cranium arising from traumatic skull bone fracture, cranial bone deformities and bone cancer and infections. Surgery involving the use of biocompatible materials, and repair or regeneration of large cranial defects is particularly challenging from both the functional and aesthetic point of view (De Santis et al. 2010; Piitulainen et al. 2015; Unterhofer et al. 2017).
Pulsed radiofrequency energy device (PEAK plasmablade™) and CustomBone® Cranioplasty: an appealing surgical rendez-vous
Published in British Journal of Neurosurgery, 2023
F. Graziano, R. Maugeri, G. R. Giammalva, E. Lo Bue, G. Zabbia, D. G. Iacopino
Cranioplasty is a surgical procedure that aims to re-establish the skull integrity following a previous craniotomy due to the occurrence of traumas, tumors and/or congenital malformations. Ideally, cranioplasty procedures should provide restoration of the protective functions of the skull with maintenance of the original aesthetics and long-term mechanical performance. The ideal material for cranioplasty should be chemically inert, biocompatible, biomechanically reliable, easily manufactured, individually shaped, safe, and able to promote osteoblast migration. Hydroxyapatite (HA) has for decades been widely considered as the gold standard for bone scaffolds, as its composition is very close to that of bone mineral, thus exhibiting excellent biocompatibility, a low inflammatory reaction as well as good osteogenic ability and osteoconductivity (Figure 1).1–5
Malignant cerebral edema after cranioplasty: a case report and literature review
Published in Brain Injury, 2023
Shaoxiong Wang, Yongxin Luan, Tao Peng, Guangming Wang, Lixiang Zhou, Wei Wu
Cranioplasty is a common treatment for patients undergoing decompression craniectomy (DC) due to craniocerebral trauma, acute cerebral infarction, and cerebral hemorrhage, etc, and is generally regarded as a simple and conventional operation. It can get control of the patient’s appearance, protect the brain tissue, and improve the cognitive ability of patients with cognitive dysfunction caused by skull defects. It can improve patient’s cognitive ability, protect brain tissue, and restore the cranium appearance (1). Complications of cranioplasty may amount to 41% (2).Frequent complications after cranioplasty mainly include postoperative infection, wound healing the disorder, epidural hematoma, and implant displacement (3,4), malignant cerebral edema rarely occurs after cranioplasty but would lead to a high fatality rate if occurred. Previous studies are agreed that the size of the skull defect, the traumatic etiology, and bilateral repair are risk factors for complications after the surgery. The risk of complications would increase even 12 months after cranioplasty (5) .However, risk factors related to malignant cerebral edema remain unclear. This article reports a case of death from malignant cerebral after cranioplasty and reviews previous literature to explore the potential causes and clinical manifestations of this rare complication.
Post-traumatic hydrocephalus may be associated with autologous cranioplasty failure, independent of ventriculoperitoneal shunt placement: a retrospective analysis
Published in British Journal of Neurosurgery, 2022
Carole S. L. Spake, Dardan Beqiri, Vinay Rao, Joseph W. Crozier, Konstantina A. Svokos, Albert S. Woo
Despite the key advantages of autologous cranioplasty, failure rates are still high, ranging from 10.4% to 29%.2,12,13,15,16 We observed a similar failure rate of 14.2% in our study population. It is important to note that not all complications led to cranioplasty failure. Interestingly, among the 127 patients who underwent CP, 48 patients suffered complications and 40% of these patients went on to experience failure. Mechanisms most closely associated with autologous bone flap failure have been studied in the past, citing bone flap resorption and infection as most common.7,15 Similarly, we found bone flap resorption (50%) and infection (29.4%) to be the two most common factors associated with failed cranioplasty in our cohort.