400 Custom Implant Cranioplasties In 5 Years: Preferred technique, Timing And Biomaterials
Amir Y. Wolff, DMD, Gabriel F. Santiago, MD, Micah Balzberg, BS, Charity Huggins, BS, Michael Lim, MD, Jon Weingart, MD, William Anderson, PhD, MD, Alex Coon, MD, Judy Huang, MD, Henry Brem, MD, Chad R. Gordon, DO, FACS.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
PURPOSE: Complex cranial defects requiring delayed reconstruction present numerous challenges. Delayed cranioplasties are accompanied with frequent complications approaching an incidence of 35-40%. As such, we sought to collate our experience in hopes of sharing our perspective on several topics including technique, timing, and preferred biomaterials.
METHODS: Details of our 5-year experience with 400 custom cranial implants is described herein. Since its inception, our Multidisciplinary Adult Cranioplasty Center (MACC) has employed the pericranial-onlay cranioplasty technique instead of the standard epidural dissection approach. Optimal timing for cranioplasty is determined using objective criteria such as incisional scalp healing and parenchymal edema. Other details include a close collaboration amongst neurosurgery and craniofacial surgery, full optimization of comorbidities, conversion from autologous bone to sterile implant in instances of questionable viability and storage, and the first line use of solid poly-methyl-methacrylate (PMMA) implants for uncomplicated, delayed cases and porous polyethylene for single-stage reconstruction. Furthermore, the use of our temporal bulking design algorithm for customized implants helps to correct and/or prevent temporal hollowing deformities.
RESULTS: We have observed a three-fold reduction in complications as compared to the literature, with a major complication rate of 11.5% for all uncomplicated cases. Our multidisciplinary center has provided the optimal stage for synergy and improved outcomes versus standard techniques.
CONCLUSION: Secondary cranial reconstruction, or cranioplasty, can be challenging due to numerous reasons. These best practices were developed in close collaboration with several specialties and appear to encompass the largest published experience to date. We find this approach both safe and reliable.
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