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Stephen Honeybul - One of the best experts on this subject based on the ideXlab platform.
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A randomised controlled trial comparing autologous Cranioplasty with custom-made titanium Cranioplasty: long-term follow-up
Acta Neurochirurgica, 2018Co-Authors: Stephen Honeybul, David Anthony Morrison, Christopher R. P. Lind, Kwok M. Ho, Elizabeth GeelhoedAbstract:Objective To compare the long-term outcomes of patients who had been randomly allocated to receive primary titanium Cranioplasty or autologous bone graft following decompressive craniectomy. Methods Sixty-four patients had been previously enrolled and randomised to receive either their own bone graft or a primary titanium Cranioplasty. Functional and cosmetic outcomes had previously been assessed at 1-year following the Cranioplasty procedure. Hospital records and the Picture Archiving communication system were reviewed to determine how many patients had Cranioplasty failure or associated complications such as seizures beyond 1 year—with a minimum of 24-month follow-up. Results Amongst the 31 patients in the titanium group (one patient had died), no patients had a partial or complete Cranioplasty failure at 12 months follow-up and there had been no failures beyond 12 months. Amongst the 31 patients who had an autologous Cranioplasty (one patient had died), 7 patients had complete resorption of the autologous bone such that it was adjudged a complete failure at 12-month follow-up. Five of these patients had had titanium augmentation and two patients declined further surgery. Both of these patients requested cranial augmentation for functional and cosmetic reasons subsequent to the 12-month follow-up. Another patient who had previously been noted to have moderate resorption at 12 months presented 1 year later with progressive bone flap resorption and also required subsequent augmentation for functional and cosmetic reasons. When follow-up was extended to a minimum of 24 months, use of titanium instead of autologous bone for primary Cranioplasty resulted in a significant reduction in the number of patients who required rescue Cranioplasty (0 vs 25%, 95% confidence interval [CI] 9.1–42.1%; p = 0.001). In addition, there were significantly less total hospital healthcare costs in those patients randomised to the titanium arm of the trial (difference = A$9999, 95%CI 2231–17,768; p = 0.015). Conclusions Bone resorption continued to occur beyond 12 months after autologous Cranioplasty; use of primary titanium Cranioplasty after decompressive craniectomy reduced the number of reoperations needed and the associated long-term total hospital costs.
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Cranioplasty: morbidity and failure
British journal of neurosurgery, 2016Co-Authors: Stephen HoneybulAbstract:AbstractObjective: Cranioplasty is a technically straightforward procedure; however, it is becoming increasingly apparent that it is associated with relatively high morbidity and a significant failure rate due to either infection or autologous bone flap resorption. The aim of this study was to determine which factors influenced the incidence of Cranioplasty complications and failure.Methods: A retrospective analysis was undertaken of all patients who had a Cranioplasty at the two major trauma hospitals in Western Australia between the start of 2004 and the middle of 2015.Results: Five hundred and twelve had a Cranioplasty after craniectomy for a variety of different indications. Sixty-three patients developed a postoperative intracranial collection following Cranioplasty (12.3%, 95% confidence interval [CI] 9.7–15.4), however only 19 required surgical evacuation. One hundred and twenty-one patients had seizures following Cranioplasty (23.6%, 95% CI 20.2–27.5) Nine patients died within six months following...
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A randomized controlled trial comparing autologous Cranioplasty with custom-made titanium Cranioplasty
Journal of neurosurgery, 2016Co-Authors: Stephen Honeybul, David Anthony Morrison, Christopher R. P. Lind, Elizabeth GeelhoedAbstract:OBJECTIVE Autologous bone is usually used to reconstruct skull defects following decompressive surgery. However, it is associated with a high failure rate due to infection and resorption. The aim of this study was to see whether it would be cost-effective to use titanium as a primary reconstructive material. METHODS Sixty-four patients were enrolled and randomized to receive either their own bone or a primary titanium Cranioplasty. All surgical procedures were performed by the senior surgeon. Primary and secondary outcome measures were assessed at 1 year after Cranioplasty. RESULTS There were no primary infections in either arm of the trial. There was one secondary infection of a titanium Cranioplasty that had replaced a resorbed autologous Cranioplasty. In the titanium group, no patient was considered to have partial or complete Cranioplasty failure at 12 months of follow-up (p = 0.002) and none needed revision (p = 0.053). There were 2 deaths unrelated to the Cranioplasty, one in each arm of the trial. Among the 31 patients who had an autologous Cranioplasty, 7 patients (22%) had complete resorption of the autologous bone such that it was deemed a complete failure. Partial or complete autologous bone resorption appeared to be more common among young patients than older patients (32 vs 45 years old, p = 0.013). The total cumulative cost between the 2 groups was not significantly different (mean difference A$3281, 95% CI $-9869 to $3308; p = 0.327). CONCLUSIONS Primary titanium Cranioplasty should be seriously considered for young patients who require reconstruction of the skull vault following decompressive craniectomy. Clinical trial registration no.: ACTRN12612000353897 ( anzctr.org.au ).
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Cranioplasty with custom-made titanium plates-14 years experience
Neurosurgery, 2012Co-Authors: Anthony Wiggins, Richard Austerberry, David Anthony Morrison, Stephen HoneybulAbstract:BACKGROUND: There is no consensus on which material is best suited for repair of cranial defects. OBJECTIVE: To investigate the outcomes following custom-made titanium Cranioplasty. METHODS: The medical records for all patients who had titanium Cranioplasty at 2 major neurosurgical centers in Western Australia were retrieved and analyzed for this retrospective cohort study. RESULTS: Altogether, 127 custom-made titanium cranioplasties on 113 patients were included. Two patients had 3 titanium cranioplasties and 10 patients had 2. Infected bone flap (n = 61, 54%), either from previous craniotomy or autologous Cranioplasty, and contaminated bone flap (n = 16, 14%) from the initial injury were the main reasons for requiring titanium Cranioplasty. Complications attributed to titanium Cranioplasty were common (n = 33, 29%), with infection being the most frequent complication (n = 18 patients, 16%). Complications were, on average, associated with an extra 7 days of hospital stay (interquartile range 2-17). The use of titanium as the material for the initial Cranioplasty (P = .58), the presence of skull fracture(s) (P . .99) or scalp laceration (s) (P = .32) at the original surgery, and proven local infection before titanium Cranioplasty (P = .78) were not significantly associated with an increased risk of infection. Infection was significantly more common after titanium Cranioplasty for large defects (hemicraniectomy [39%] and bifrontal craniectomy [28%]) than after Cranioplasty for small defects (P = .04). CONCLUSION: Complications after using titanium plate for primary or secondary Cranioplasty were common (29%) and associated with an increased length of hospital stay. Infection was a major complication (16%), and this suggested that more vigorous perioperative infection prophylaxis is needed for titanium plate Cranioplasty.
Yadranko Ducic - One of the best experts on this subject based on the ideXlab platform.
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Progressive Scalp Thinning Over Mesh Cranioplasty and the Role of Lipotransfer
The Laryngoscope, 2019Co-Authors: Weitao Wang, Aurora Vincent, Arash Bahrami, Tom Shokri, Jared C. Inman, Yadranko DucicAbstract:Objectives To evaluate the role of lipotransfer in progressive scalp thinning following titanium mesh Cranioplasty. Methods Retrospective review of single surgeon, single tertiary referral experience of all patients who underwent mesh Cranioplasty. Patient demographics, prior radiotherapy, frequency and timing of scalp thinning, and treatment course data were obtained. Results A total of 144 patients were included, 77 male and 67 female with mean ages 58.2 and 54.8, respectively. One hundred four patients (72%) developed mesh exposure or impending exposure requiring reconstruction. Fifty-six patients (54%) with scalp thinning were treated with lipotransfer, 40 of which were salvaged and the remainder of these patients definitively managed with Cranioplasty and reconstruction. Prior radiotherapy was found to be associated with higher rates of mesh exposure (P = .0028), but not predictive of response to lipotransfer. Conclusion Lipotransfer is a useful technique in managing moderate scalp thinning following mesh Cranioplasty. Mesh exposure or severe thinning require definitive Cranioplasty and reconstruction. Level of evidence IV Laryngoscope, 130: 1926-1931, 2020.
Mark P. Piedra - One of the best experts on this subject based on the ideXlab platform.
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complications following pediatric Cranioplasty after decompressive craniectomy a multicenter retrospective study
Journal of Neurosurgery, 2018Co-Authors: Brandon G Rocque, Mark P. Piedra, Nathan R Selden, Eric M. Thompson, Bonita S Agee, Lissa C Baird, Stephanie Greene, Christopher P Deibert, Todd C Hankinson, Sean M LewAbstract:OBJECTIVE In children, the repair of skull defects arising from decompressive craniectomy presents a unique set of challenges. Single-center studies have identified different risk factors for the common complications of Cranioplasty resorption and infection. The goal of the present study was to determine the risk factors for bone resorption and infection after pediatric Cranioplasty. METHODS The authors conducted a multicenter retrospective case study that included all patients who underwent Cranioplasty to correct a skull defect arising from a decompressive craniectomy at 13 centers between 2000 and 2011 and were less than 19 years old at the time of Cranioplasty. Prior systematic review of the literature along with expert opinion guided the selection of variables to be collected. These included: indication for craniectomy; history of abusive head trauma; method of bone storage; method of bone fixation; use of drains; size of bone graft; presence of other implants, including ventriculoperitoneal (VP) shunt; presence of fluid collections; age at craniectomy; and time between craniectomy and Cranioplasty. RESULTS A total of 359 patients met the inclusion criteria. The patients' mean age was 8.4 years, and 51.5% were female. Thirty-eight cases (10.5%) were complicated by infection. In multivariate analysis, presence of a cranial implant (primarily VP shunt) (OR 2.41, 95% CI 1.17-4.98), presence of gastrostomy (OR 2.44, 95% CI 1.03-5.79), and ventilator dependence (OR 8.45, 95% CI 1.10-65.08) were significant risk factors for Cranioplasty infection. No other variable was associated with infection. Of the 240 patients who underwent a Cranioplasty with bone graft, 21.7% showed bone resorption significant enough to warrant repeat surgical intervention. The most important predictor of Cranioplasty bone resorption was age at the time of Cranioplasty. For every month of increased age the risk of bone flap resorption decreased by 1% (OR 0.99, 95% CI 0.98-0.99, p < 0.001). Other risk factors for resorption in multivariate models were the use of external ventricular drains and lumbar shunts. CONCLUSIONS This is the largest study of pediatric Cranioplasty outcomes performed to date. Analysis included variables found to be significant in previous retrospective reports. Presence of a cranial implant such as VP shunt is the most significant risk factor for Cranioplasty infection, whereas younger age at Cranioplasty is the dominant risk factor for bone resorption.
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timing of Cranioplasty after decompressive craniectomy for trauma
Surgical Neurology International, 2014Co-Authors: Mark P. Piedra, Andrew Nemecek, Brian T. RagelAbstract:Background: The optimal timing of Cranioplasty after decompressive craniectomy for trauma is unknown. The aim of this study was to determine if early Cranioplasty after decompressive craniectomy for trauma reduces complications. Methods: Consecutive cases of patients who underwent autologous Cranioplasty after decompressive craniectomy for trauma at a single Level I Trauma Center were studied in a retrospective 10 year data review. Associations of categorical variables were compared using Chi‑square test or Fisher’s exact test. Results: A total of 157 patients were divided into early (<12 weeks; 78 patients) and late (≥12 weeks; 79 patients) Cranioplasty cohorts. Baseline characteristics were similar between the two cohorts. Cranioplasty operative time was significantly shorter in the early (102 minutes) than the late (125 minutes) Cranioplasty cohort (P = 0.0482). Overall complication rate in both cohorts was 35%. Infection rates were lower in the early (7.7%) than the late (14%) Cranioplasty cohort as was bone graft resorption (15% early, 19% late), hydrocephalus rate (7.7% early, 1.3% late), and postoperative hematoma incidence (3.9% early, 1.3% late). However, these differences were not statistically significant. Patients <18 years of age were at higher risk of bone graft resorption than patients ≥18 years of age (OR 3.32, 95% CI 1.25-8.81; P = 0.0162). Conclusions: After decompressive craniectomy for trauma, early (<12 weeks) Cranioplasty does not alter the incidence of complication rates. In patients <18 years of age, early (<12 weeks) Cranioplasty increases the risk of bone resorption. Delaying Cranioplasty (≥12 weeks) results in longer operative times and may increase costs.
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timing of Cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke
Journal of Neurosurgery, 2013Co-Authors: Mark P. Piedra, Brian T. Ragel, Nicholas D Coppa, Aclan Dogan, Johnny B DelashawAbstract:Object The optimal timing of Cranioplasty after decompressive craniectomy for stroke is not known. Case series suggest that early Cranioplasty is associated with higher rates of infection while delaying Cranioplasty may be associated with higher rates of bone resorption. The authors examined whether the timing of Cranioplasty after decompressive craniectomy for stroke affects postoperative complication rates. Methods A retrospective cohort study was undertaken to evaluate complication rates in patients undergoing Cranioplasty at early (within 10 weeks of craniectomy) or late (≥ 10 weeks) stages. Multivariate logistic regression analysis was used to determine characteristics that would predict complications in patients undergoing Cranioplasty after decompressive craniectomy for stroke. Results While the overall complication rate was higher in the early Cranioplasty cohort (22% vs 16% in the late Cranioplasty cohort), the difference was not statistically significant (p = 0.5541). Patients in the early crani...
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optimal timing of autologous Cranioplasty after decompressive craniectomy in children
Journal of Neurosurgery, 2012Co-Authors: Mark P. Piedra, Brian T. Ragel, Nathan R Selden, Eric M. Thompson, Daniel J GuillaumeAbstract:OBJECT: The object of this study was to determine if early Cranioplasty after decompressive craniectomy for elevated intracranial pressure in children reduces complications. METHODS: Sixty-one consecutive cases involving pediatric patients who underwent autologous Cranioplasty after decompressive craniectomy for raised intracranial pressure at a single academic children's hospital over 15 years were studied retrospectively. RESULTS: Sixty-one patients were divided into early (< 6 weeks; 28 patients) and late (≥ 6 weeks; 33 patients) Cranioplasty cohorts. The cohorts were similar except for slightly lower age in the early (8.03 years) than the late (10.8 years) Cranioplasty cohort (p < 0.05). Bone resorption after Cranioplasty was significantly more common in the late (42%) than the early (14%) Cranioplasty cohort (p < 0.05; OR 5.4). No other complication differed in incidence between the cohorts. CONCLUSIONS: After decompressive craniectomy for raised intracranial pressure in children, early (< 6 weeks) Cranioplasty reduces the occurrence of reoperation for bone resorption, without altering the incidence of other complications.
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optimal timing of autologous Cranioplasty after decompressive craniectomy in children
Journal of Neurosurgery, 2012Co-Authors: Mark P. Piedra, Brian T. Ragel, Nathan R Selden, Eric M. Thompson, Daniel J GuillaumeAbstract:Object The object of this study was to determine if early Cranioplasty after decompressive craniectomy for elevated intracranial pressure in children reduces complications. Methods Sixty-one consecutive cases involving pediatric patients who underwent autologous Cranioplasty after decompressive craniectomy for raised intracranial pressure at a single academic children's hospital over 15 years were studied retrospectively. Results Sixty-one patients were divided into early (< 6 weeks; 28 patients) and late (≥ 6 weeks; 33 patients) Cranioplasty cohorts. The cohorts were similar except for slightly lower age in the early (8.03 years) than the late (10.8 years) Cranioplasty cohort (p < 0.05). Bone resorption after Cranioplasty was significantly more common in the late (42%) than the early (14%) Cranioplasty cohort (p < 0.05; OR 5.4). No other complication differed in incidence between the cohorts. Conclusions After decompressive craniectomy for raised intracranial pressure in children, early (< 6 weeks) crani...
Jincao Chen - One of the best experts on this subject based on the ideXlab platform.
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The application of polyetheretherketone (PEEK) implants in Cranioplasty
Brain Research Bulletin, 2019Co-Authors: Jibo Zhang, Weiqun Tian, Jianjian Zhang, Jiayi Chen, Jin Yu, Jincao ChenAbstract:Abstract Cranioplasty is a challenge to neurosurgeons, especially considering protection of intracranial contents. In recent years, material choice for Cranioplasty is still controversial, which brings complexity to this seemingly straightforward procedure. PEEK, a tough, rigid, biocompatible material, has been used more recently in Cranioplasty to provide better protection. The aim of this review is to summarize the outcome of research conducted on the material for Cranioplasty applications. We also reviewed the comparison of PEEK with several common materials in previous articles. This is also the most complete data review article at present. In addition, the combination of nano-materials and PEEK is also a hotspot of research, so we have made a careful review of this aspect. We also summarized our own experience, telling about the future prospects of PEEK in the field of clinical Cranioplasty should be highlighted. Improving the bioactivity, porosity, thinning, biocompatibility, antibacterial ability, integration and cost reduction of PEEK implants without affecting their mechanical properties is a major challenge.
Ivan Ng - One of the best experts on this subject based on the ideXlab platform.
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Comparison of polyetheretherketone and titanium Cranioplasty after decompressive craniectomy
World Neurosurgery, 2015Co-Authors: Ady Thien, Beng Ti Ang, Nicolas K K King, Ernest Wang, Ivan NgAbstract:Objective To characterize complication and failure rates and outcomes of patients who underwent Cranioplasty with polyetheretherketone (PEEK) and titanium implants and to compare complication and failure rates between the 2 implants. Methods A retrospective cohort study of patients who underwent Cranioplasty with PEEK patient-specific implant (PEEK Optima-LT) and preformed titanium mesh at the National Neuroscience Institute, Singapore, between January 2001 and February 2012 was performed. Data related to initial decompressive craniectomy and Cranioplasty, associated complications after Cranioplasty, and indication for revision or removal of implants were collected. Cranioplasty failure was defined as revision or removal of a patient's implant. Results Overall complication rates for PEEK and titanium Cranioplasty were 25.0% and 27.8%, respectively. The combined complication rate was 27.3%. A trend toward increase in exposed implant in titanium Cranioplasty compared with PEEK Cranioplasty was observed (P = 0.074). There were 3 of 24 (12.5%) Cranioplasty failures with PEEK, and 27 of 108 (25%) Cranioplasty failures with titanium (P = 0.129). Previous deep infection in patients after decompressive craniectomy was associated with Cranioplasty complications (odds ratio, 23.3; confidence interval, 3.00-180.5; P = 0.003) and failure (odds ratio, 22.5; confidence interval, 2.82-179.0; P = 0.003). Conclusions The findings from this study highlight that Cranioplasty is associated with significant complications, including the necessity for reoperation. It is hoped that the information in this study will provide better understanding of the risks associated with PEEK and titanium Cranioplasty and contribute to decision making by the clinician and patient.