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Cranioplasty for large skull defects with PMMA (Polymethylmethacrylate) or Tutoplast processed autogenic bone grafts.
Zentralbl Neurochir. 2007 Nov; 68(4):182-9.ZN

Abstract

OBJECTIVE

Aim of the study was a comparison of cranioplasty using the Tutoplast technology for autogenic bone processing and conventional polymethylmethacrylate (PMMA) calvarial re- construction.

PATIENTS AND METHODS

A retrospective analysis was carried out in a consecutive series of 61 plastic reconstructions for skull defects, the largest measuring more than 12 cm. Cranioplasty was either performed with PMMA or with the patient's own bone graft which had been recycled using the Tutoplast process.

RESULTS

36 patients with a mean age of 44 (range 10-68) years underwent freehand PMMA cranioplasty following craniectomy for increased intracranial pressure (19 patients, 52.8%), infection (15 patients, 41.7%), or traumatic bone destruction (2 patients, 5.6%). Bilateral procedures were performed in 10 patients (27.8%). Mean follow-up was 44 months. Four patients (11.1%) died, 14 (38.9%) remained severely disabled, and 18 (50%) made a satisfactory recovery. Two patients (5.6%) had PMMA-related complications and required removal. 26 patients exhibited at least satisfactory cosmetic results (83.9%), in 5 patients the results were not satisfactory (16.1%) and in 5 the results are unknown. Twenty-five patients with a mean age of 42 (range 2-68) years received Tutoplast processed autografts following craniectomy for elevated intracranial pressure. Bilateral procedures were performed in 3 patients (12%). Mean follow-up was 15 months. One patient (4%) died, 18 (72%) remained severely disabled, and 6 (24%) made a satisfactory recovery. All patients had satisfactory cosmetic results, but 2 patients (8.3%) required removal at a later stage, one due to infection (4.2%) and one for bone resorption (4.2%). In the 18 patients with follow-up >0.5 years significant resorption occurred in all 5 children and adolescents (100%) and in two adult patients (15.4%).

CONCLUSION

Cosmetic results were more satisfactory with Tutoplast processed autografts, and the operating time for unilateral surgery was shorter. Complication rates were similar. Resorption occurred in all children and adolescents, but was rare in adults. Thus, Tutoplast processed autogenic bone grafts can be a reasonable alternative to other methods of cranioplasty in adult patients with large craniotomy defects. Cranioplasty in children and adolescents remains an unsolved problem.

Authors+Show Affiliations

Neurochirurgische Klinik, Universitätsklinikum Bonn, Bonn, Germany.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17966077

Citation

Kriegel, R J., et al. "Cranioplasty for Large Skull Defects With PMMA (Polymethylmethacrylate) or Tutoplast Processed Autogenic Bone Grafts." Zentralblatt Fur Neurochirurgie, vol. 68, no. 4, 2007, pp. 182-9.
Kriegel RJ, Schaller C, Clusmann H. Cranioplasty for large skull defects with PMMA (Polymethylmethacrylate) or Tutoplast processed autogenic bone grafts. Zentralbl Neurochir. 2007;68(4):182-9.
Kriegel, R. J., Schaller, C., & Clusmann, H. (2007). Cranioplasty for large skull defects with PMMA (Polymethylmethacrylate) or Tutoplast processed autogenic bone grafts. Zentralblatt Fur Neurochirurgie, 68(4), 182-9.
Kriegel RJ, Schaller C, Clusmann H. Cranioplasty for Large Skull Defects With PMMA (Polymethylmethacrylate) or Tutoplast Processed Autogenic Bone Grafts. Zentralbl Neurochir. 2007;68(4):182-9. PubMed PMID: 17966077.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cranioplasty for large skull defects with PMMA (Polymethylmethacrylate) or Tutoplast processed autogenic bone grafts. AU - Kriegel,R J, AU - Schaller,C, AU - Clusmann,H, Y1 - 2007/10/26/ PY - 2007/10/30/pubmed PY - 2008/2/8/medline PY - 2007/10/30/entrez SP - 182 EP - 9 JF - Zentralblatt fur Neurochirurgie JO - Zentralbl Neurochir VL - 68 IS - 4 N2 - OBJECTIVE: Aim of the study was a comparison of cranioplasty using the Tutoplast technology for autogenic bone processing and conventional polymethylmethacrylate (PMMA) calvarial re- construction. PATIENTS AND METHODS: A retrospective analysis was carried out in a consecutive series of 61 plastic reconstructions for skull defects, the largest measuring more than 12 cm. Cranioplasty was either performed with PMMA or with the patient's own bone graft which had been recycled using the Tutoplast process. RESULTS: 36 patients with a mean age of 44 (range 10-68) years underwent freehand PMMA cranioplasty following craniectomy for increased intracranial pressure (19 patients, 52.8%), infection (15 patients, 41.7%), or traumatic bone destruction (2 patients, 5.6%). Bilateral procedures were performed in 10 patients (27.8%). Mean follow-up was 44 months. Four patients (11.1%) died, 14 (38.9%) remained severely disabled, and 18 (50%) made a satisfactory recovery. Two patients (5.6%) had PMMA-related complications and required removal. 26 patients exhibited at least satisfactory cosmetic results (83.9%), in 5 patients the results were not satisfactory (16.1%) and in 5 the results are unknown. Twenty-five patients with a mean age of 42 (range 2-68) years received Tutoplast processed autografts following craniectomy for elevated intracranial pressure. Bilateral procedures were performed in 3 patients (12%). Mean follow-up was 15 months. One patient (4%) died, 18 (72%) remained severely disabled, and 6 (24%) made a satisfactory recovery. All patients had satisfactory cosmetic results, but 2 patients (8.3%) required removal at a later stage, one due to infection (4.2%) and one for bone resorption (4.2%). In the 18 patients with follow-up >0.5 years significant resorption occurred in all 5 children and adolescents (100%) and in two adult patients (15.4%). CONCLUSION: Cosmetic results were more satisfactory with Tutoplast processed autografts, and the operating time for unilateral surgery was shorter. Complication rates were similar. Resorption occurred in all children and adolescents, but was rare in adults. Thus, Tutoplast processed autogenic bone grafts can be a reasonable alternative to other methods of cranioplasty in adult patients with large craniotomy defects. Cranioplasty in children and adolescents remains an unsolved problem. SN - 0044-4251 UR - https://www.unboundmedicine.com/medline/citation/17966077/Cranioplasty_for_large_skull_defects_with_PMMA__Polymethylmethacrylate__or_Tutoplast_processed_autogenic_bone_grafts_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-985857 DB - PRIME DP - Unbound Medicine ER -