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1.
Cranioplasty with autogenous autoclaved calvarial bone flap in the cases of tumoural invasion 总被引:2,自引:0,他引:2
V. Vanaclocha N. Sáiz-Sapena C. Garcia-Casasola E. De Alava 《Acta neurochirurgica》1997,139(10):970-976
Summary When a bone flap is raised in the course of a craniotomy, the ideal is to replace it at the end of the procedure. When it is invaded by tumoural cells, it cannot be replaced due to the risk of tumoural recurrence. In these cases we have autoclaved the bone flap to be able to replace it with no fear of tumoural recurrence.Between October 1989 and October 1995 sixty-two patients required autoclaving of the bone flap in the course of a craniotomy due to tumoural invasion (thirty-five meningiomas, sixteen bone tumours, five metastases, and eight scalp tumours).The infiltrated bone flaps were removed, cleaned, autoclaved for 20 minutes at 134 °C and 1 kg/cm2 and re-implanted.Patients were followed-up for 10 to 58 months (average 41 months). At every follow-up visit skull x-ray studies, clinical examination, and photographs were done. When needed a CT scan was performed to assess the thickness of the bone flap.On follow-up roentgenograms partial resorption was observed in twelve cases (19.3%). CT scan studies showed loss of thickness in another thirty-five cases (56.4%). Meanwhile the external aspect remained unchanged.In six cases (3.2%) biopsies of the bone flaps were taken at a second surgical procedure. They showed newly formed bone partly re-populated by osteocytes but retaining areas of sequestered bone.We conclude that autoclaved bone, if replaced with direct contact with living bone, it is gradually repopulated with osteocytes. Cranial vault autoclaved autologous bone flap is a good alternative when the original bone flap is invaded but not destroyed by tumoural cells. 相似文献
2.
目的研究Arnold—Chiari畸形合并脊髓空洞症显微外科手术中后颅窝底及寰椎后弓切除对脑组织和寰枕部稳定性的影响及钛网后颅窝扩大成形术对保持后颅窝结构、功能稳定的临床应用。方法对12例Arnold—Chiari畸形钛网后颅窝及寰椎后弓扩大成形患者与156例未成型患者的术后临床症状、枕颈部的稳定性及生活质量进行对照。结果12例扩大成型患者术后临床症状不明显,生活质量高;而未成型者多有头痛、头晕、枕颈交界部不适等症状以及惧怕枕颈部遭受外力的恐惧心理。结论钛网后颅窝及环椎后弓扩大成形术可相对维持后颅窝的生理结构,减少患者的临床症状,提高生活质量。 相似文献
3.
目的探讨颅骨缺损修补手术的适应证、时机、修补材料、技巧及并发症的防治。方法对73例颅骨缺损行钛合金网颅骨修补手术患者的临床资料进行回顾性分析。结果颅骨缺损用钛合金网修补,手术方法为覆盖法,颅骨修补手术时间术后立即修补3例,其余距受伤3个月~1年。术后36例原有轻头痛、头晕不同程度改善;12例不明显;术前8例肢体偏瘫患者术后症状有明显改善;术前癫痫1例,术后配合药物治疗症状消失,无手术死亡病例。结论对于颅骨缺损直径≥3cm、缺损部位在额部、颞、顶部等,应当及时行修补术。目前手术材料选用钛合金网,其手术方法最简单,并发症最少,疗效最佳。 相似文献
4.
Mehmet Sabri Gürbüz Ozgur Celik Mehmet Zafer Berkman 《Journal of Korean Neurosurgical Society》2012,52(5):498-500
Cranioplasty is performed using autograft and allograft materials on patients to whom craniectomy was applied previously due to the facts that, this region is open to trauma and the scalp makes irritation and pressure onto the brain paranchyma causing brain atrophy and convulsions. Dramatical improvement of neurological deficits, control of convulsions and partial prevention of cerebral atrophy are achieved after these operations. One of the most important complications of cranioplasty is late infection. Here, we report a 43-year-old male patient admitted with the history of purulant discharge from the right temporal incission site for one year to whom cranioplasty had been performed with allograft material 20 days after craniectomy which had been performed in 1989. Allograft cranioplasty material was removed and cranioplasty was performed using new allograft material with the diagnosis of late cranioplasty infection. 相似文献
5.
《Neuro-Chirurgie》2021,67(4):301-309
BackgroundRepairing bone defects generated by craniectomy is a major therapeutic challenge in terms of bone consolidation as well as functional and cognitive recovery. Furthermore, these surgical procedures are often grafted with complications such as infections, breaches, displacements and rejections leading to failure and thus explantation of the prosthesis.ObjectiveTo evaluate cumulative explantation and infection rates following the implantation of a tailored cranioplasty CUSTOMBONE prosthesis made of porous hydroxyapatite. One hundred and ten consecutive patients requiring cranial reconstruction for a bone defect were prospectively included in a multicenter study constituted of 21 centres between December 2012 and July 2014. Follow-up lasted 2 years.ResultsMean age of patients included in the study was 42 ± 15 years old (y.o), composed mainly by men (57.27%). Explantations of the CUSTOMBONE prosthesis were performed in 13/110 (11.8%) patients, significantly due to infections: 9/13 (69.2%) (p < 0.0001), with 2 (15.4%) implant fracture, 1 (7.7%) skin defect and 1 (7.7%) following the mobilization of the implant. Cumulative explantation rates were successively 4.6% (SD 2.0), 7.4% (SD 2.5), 9.4% (SD 2.8) and 11.8% (SD 2.9%) at 2, 6, 12 and 24 months. Infections were identified in 16/110 (14.5%): 8/16 (50%) superficial and 8/16 (50%) deep. None of the following elements, whether demographic characteristics, indications, size, location of the implant, redo surgery, co-morbidities or medical history, were statistically identified as risk factors for prosthesis explantation or infection.ConclusionOur study provides relevant clinical evidence on the performance and safety of CUSTOMBONE prosthesis in cranial procedures. Complications that are difficulty incompressible mainly occur during the first 6 months, but can appear at a later stage (> 1 year). Thus assiduous, regular and long-term surveillances are necessary. 相似文献
6.
Cranioplasty is a relatively straightforward and common procedure, yet it carries a substantial rate of infection that causes major morbidity and mortality. The authors’ objective was to assess the effect of various variables on the risk of developing post-cranioplasty infections, and to enable the prediction and reduction of its incidence, contributing to an improved patient-selection. The medical records, microbiologic cultures, imaging studies and operative reports of patients who have undergone cranioplasty between the years 2008–2014 at Sheba Medical Center, a tertiary care teaching hospital in Tel-Hashomer, Israel, were reviewed and evaluated for potential predictive factors of infection. Cox regression was applied for uni- as well as multi-variate analyses, and a Kaplan–Meier curve and Log-Rank test were used to describe the association between neurological deficit prior to operation and occurrence of infection. Eighty-eight patients who had undergone cranioplasties using autologous as well as various artificial materials were included in the study. The overall rate of infection was 13.6%; median time to infection was 30.5 days (interquartile range: 17.35–43.5). Pre-operative degree of neurological disability was the strongest predictor for infection in both uni- and multi-variate analyses (Hazard ratio [HR] = 18.9, 95% confidence interval [CI]: 1.9–187 p = 0.014). Patients admitted due to trauma (HR = 7.04 CI: 0.9–54.6, p = 0.062) and autologous graft material (HR = 2.88, 95% CI: 0.92–9.09, p = 0.07) were associated with a trend toward a higher risk for infection. In conclusion, careful patient selection is a key concept in avoiding harmful post-cranioplasty infections. Modified Rankin Score yields a well-established tool that predicts the risk of infection. 相似文献
7.
E. Maravelakis K. David A. Antoniadis A. Manios N. Bilalis Y. Papaharilaou 《Journal of medical engineering & technology》2013,37(2):115-121
This paper presents rapid prototyping and reverse engineering techniques applied to create an implant for the surgical reconstruction of a large cranial defect. A series of computed tomography (CT) images was obtained and purpose built software was used to extract the cranial geometry in a point cloud. The point cloud produced was used for: (a) the creation of a stereolithographic (STL) physical model for direct assessment of the cranial defect; and (b) the creation of a 3D mould model for the fabrication of the patient-specific implant. 相似文献
8.
《Journal of cranio-maxillo-facial surgery》2021,49(9):815-822
BackgroundThis study aimed to describe the surgical technique of reverse frontal cranioplasty (RFC), the aesthetical modification as well as the modification of intracranial volume (ICV) to assess its potential eligibility for the treatment of the intracranial hypertension (IH).Materials and methodsA retrospective monocentric study included the patients with a history of craniosynostosis with a forehead deformity who underwent RFC. A subjective outcome questionnaire (SOQ) was conducted with each patient or their parent to determine their level of satisfaction after RFC. Pre- and postoperative computed tomography (CT) scans were analyzed and compared to investigate the ICV change and fronto-nasal angle.ResultsEleven patients were included in the study (6 female and 5 male) with a mean age of 10.9 years old (range 3–23 years) and an average follow-up of 4.5 years (1–11 years). All patients responded to the questionnaire with a high level of overall satisfaction (mean 9.1/10). The mean preoperative FNA was 134° ± 5° while the mean postoperative angle was 126.4° ± 6, corresponding to an average decrease of 7.6° (95% CI, 4.0–11.2°; p < 0.001). One patient with preoperative IH had a clinical recurrence during the follow-up. The ICV was significantly higher after the surgery (p < 0.0001), with an average increase of 3.2% (95% CI, 2.3–4.1%).ConclusionReverse (RFC) is a useful technique for the correction of the frontal malformations related to craniosynostosis, such as a sloping forehead and/or a lack of the supraorbital projection. Regarding the limited gain of intracranial volume (ICV), it should not be used alone as primary cranial expansion surgery for craniosynostosis with intracranial hypertension (IH). 相似文献
9.
Gwang Soo Lee Sukh Que Park Rasun Kim Sung Jin Cho 《Journal of Korean Neurosurgical Society》2015,58(1):76-78
This report details a case of unexpected, severe post-operative cerebral edema following cranioplasty. We discuss the possible pathological mechanisms of this complication. A 50-year-old female was admitted to our department with sudden onset of stuporous consciousness. A brain computed tomography (CT) revealed a subarachnoid hemorrhage with intracranial hemorrhage and subdural hematoma. Emergency decompressive craniectomy and aneurysmal neck clipping were performed. Following recovery, the decision was made to proceed with an autologous cranioplasty. The cranioplasty procedure was free of complications. An epidural drain was placed and connected to a suction system during skin closure to avoid epidural blood accumulation. However, following the procedure, the patient had a seizure in the recovery room. An emergency brain CT scan revealed widespread cerebral edema, and the catheter drain was clamped. The increased intracranial pressure and cerebral edema were controlled with osmotic diuretics, corticosteroids, and antiepileptic drugs. The edema slowly subsided, but new low-density areas were noted in the brain on follow-up CT 1 week later. We speculated that placing the epidural drain on active suction may have caused an acute decrease in intracranial pressure and subsequent rapid expansion of the brain, which impaired autoregulation and led to reperfusion injury. 相似文献
10.
N. Mohan Rangan N. K. Sahoo K. Tomar P. K. Chattopadhyay 《Journal of maxillofacial and oral surgery》2015,14(3):754-760