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• W2015317596 abstract "The goal of secondary cranioplasty is permanent cerebral protection in an aesthetically acceptable fashion. Reconstruction of cranial defects can be performed with several different materials including autogenous tissue, allogeneic implants and alloplastic materials. Alloplastic materials, such as preformed methylmethacrylate (PMMA) cranioplasties are an alternative frequently used at our institution. This retrospective analysis was designed to review the outcomes of PMMA cranioplasty for skull defect reconstruction. 70 consecutive patients (52 male, 18 female) who had 78 PMMA cranioplasties placed from 2003 through 2010 were identified and a retrospective analysis was performed. Mechanism of injury, location of cranioplasty, type of original repair, post-op complications and follow-up time were reviewed. The same Maxillofacial Prosthetic Technician/Laboratory fabricated all PMMA skull inserts. Of the 70 patients; 4 had failure and removal of their original PMMA cranioplasty and re-insertion of another, 2 patients had failure and removal of 2 cranioplasties with replacement of a third, creating a total of 78 PMMA cranioplasties placed. The average age of the patients at the time of surgery was 42 years. The predominant mechanism of injury was trauma (67%). Followed by ruptured aneurysm (14%), tumors (8%), hematoma (5%), epilepsy (4%), CVA 1 (1%) and brain abscess (1%). Fifty-seven of the 78 had no repair at the time of injury. Thirteen were originally repaired with replacement of the bone flap, which was then later removed. The remaining 8 were failed PMMA cranioplasties as noted above. The average time of follow up was 327 days with a range from 0 (lost to follow-up) to 2,495 days. The most frequent post-operative complication was infection (17%). The patients returned for the infected cranioplasty between 15 and 507 days post-op (average 103). Five of the 13 infected cranioplasties were in the bilateral frontal area. The remaining were unilateral; 5 in the frontal-temporal-parietal region, 2 frontal-parietal, and 1 parietal. Seven post operative hematomas occurred between days 1 through 8 (average 2) with 3 evacuated surgically and replacement of the cranioplasty. One migration of the implant occurred on day 30, after the patient had a seizure and fell, which required repositioning. Two scalp erosions and exposure of the implants occurred on days 3 and 21. Nine patients experienced chronic headaches postoperatively. One patient had chronic postoperative pain attributed to temporalis muscle spasms. With the exception of the 2 patients with implant exposure, no patients reported an unacceptable cosmetic result. Overall, a total of 14 (18%) of the 78 were removed. The results of previous studies have shown that infection and complication rates of cranioplasties accomplished with bone cement are substantially higher, titanium based implants obscure follow-up imaging, and that the outcomes regarding HA-based ceramics while similar (in matched populations) to PMMA, are associated with a much higher cost. PMMA remains a cost effective and proven method to repair cranial defects that fulfills the goals of cranial reconstruction for skull defects." @default.
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• W2015317596 date "2011-09-01" @default.
• W2015317596 modified "2023-09-26" @default.
• W2015317596 title "Long-Term Clinical Outcome Analysis of PMMA Cranioplasty for Skull Defects" @default.
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• W2015317596 doi "https://doi.org/10.1016/j.joms.2011.06.075" @default.
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