Interval cranioplasty with patient-specific implants and autogenous bone grafts--success and cost analysis.

UNLABELLED Different options exist for the reconstruction of craniectomy defects following interval cranioplasty. The standard procedure is still based on the re-implantation of autogenous bone specimen which can be stored in the abdominal wall or be cryopreserved. Alternatively patient-specific implants (PSIs) can be used. We conducted a retrospective study based on 50 consecutive patients with skull bone defects of 100 cm(2) or more being operated on by the same team of surgeons. Thirty-three patients agreed to take part in the study. Seventeen patients who underwent reconstruction with PSIs (titanium and polyether ether ketone, PEEK) (follow-up, 43 months [range, 3-93]) were compared with 16 control subjects who had autogenous bone grafts re-implanted (follow-up, 32 months [range, 5-92]). Criteria analyzed were the success and complication rates, operation time, duration of hospitalization and the treatment costs. Complication rate and the rate of reoperation were significantly lower, and the hospital stay was shorter in the PSI group. The treatment costs for reconstruction with autogenous bone were considerably lower than skull bone reconstruction based on PSIs (average costs: 10849.91 €/patient versus 15532.08 €/patient with PSI). Due to biological reasons some of the autogenous bone implants fail due to infection and resorption and the patients have to undergo another operation with implantation of a PSI in a secondary attempt. For those patients the highest overall treatment costs must be calculated (average costs: 26086.06 €/patient with secondary stage PSI versus 15532.08 €/patient with primary stage PSI). CONCLUSION High success rates and reliability of PSIs may change the treatment strategy in patients undergoing interval cranioplasty.

[1]  Emeka Nkenke,et al.  Effects of bioactive glass and beta-TCP containing three-dimensional laser sintered polyetheretherketone composites on osteoblasts in vitro. , 2008, Journal of biomedical materials research. Part A.

[2]  Michael Schmidt,et al.  Selective laser sintering of PEEK , 2007 .

[3]  Michael Wehmöller,et al.  Geometrically structured implants for cranial reconstruction made of biodegradable polyesters and calcium phosphate/calcium carbonate. , 2004, Biomaterials.

[4]  Timm Steiner,et al.  Patient-Specific Implants Compared With Stored Bone Grafts for Patients With Interval Cranioplasty , 2014, The Journal of craniofacial surgery.

[5]  Arvind Agarwal,et al.  Plasma-sprayed carbon nanotube reinforced hydroxyapatite coatings and their interaction with human osteoblasts in vitro. , 2007, Biomaterials.

[6]  H. Eufinger,et al.  Microsurgical Tissue Transfer and Individual Computer-aided Designed and Manufactured Prefabricated Titanium Implants for Complex Craniofacial Reconstruction , 2002, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[7]  P. Patka,et al.  Long-term in vivo study of plasma-sprayed coatings on titanium alloys of tetracalcium phosphate, hydroxyapatite and α-tricalcium phosphate , 1994 .

[8]  M. Macfarlane,et al.  Titanium in reconstructive surgery of the skull and face. , 1990, British journal of plastic surgery.

[9]  F. Kloss,et al.  Degradation characteristics of α and β tri-calcium-phosphate (TCP) in minipigs , 2002 .

[10]  H. Arzate,et al.  In vitro cytotoxicity of amorphous carbon films. , 2005, Bio-medical materials and engineering.

[11]  P. Kessler,et al.  Guided bone regeneration: dynamic procedures versus static shielding in an animal model. , 2010, Journal of biomedical materials research. Part B, Applied biomaterials.

[12]  Jos Vander Sloten,et al.  A classification of cranial implants based on the degree of difficulty in computer design and manufacture , 2008, The international journal of medical robotics + computer assisted surgery : MRCAS.

[13]  U. Steinseifer,et al.  Cranioplasty with customized titanium and PEEK implants in a mechanical stress model. , 2012, Journal of neurotrauma.

[14]  Dietmar W Hutmacher,et al.  Scaffold-based tissue engineering: rationale for computer-aided design and solid free-form fabrication systems. , 2004, Trends in biotechnology.

[15]  J. Poukens,et al.  A treatment algorithm for patients with large skull bone defects and first results. , 2011, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[16]  A. Harders,et al.  Reconstruction of craniofacial bone defects with individual alloplastic implants based on CAD/CAM-manipulated CT-data. , 1995, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[17]  P. Kessler,et al.  Hydroxyapatite cement (BoneSource) for repair of critical sized calvarian defects--an experimental study. , 2003, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[18]  H Eufinger,et al.  Individual Prefabricated Titanium Implants in Reconstructive Craniofacial Surgery: Clinical and Technical Aspects of the First 22 Cases , 1998, Plastic and reconstructive surgery.

[19]  R. Tolba,et al.  Different Culture Media Affect Proliferation, Surface Epitope Expression, and Differentiation of Ovine MSC , 2013, Stem cells international.

[20]  J. Jagur-grodzinski Biomedical application of functional polymers , 1999 .

[21]  Hyoun‐Ee Kim,et al.  Biocompatibility of titanium implants modified by microarc oxidation and hydroxyapatite coating. , 2005, Journal of biomedical materials research. Part A.

[22]  F W Neukam,et al.  Effects of osteoinduction on bone regeneration in distraction: results of a pilot study. , 2010, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[23]  A. Berdal,et al.  Potential of biomimetic surfaces to promote in vitro osteoblast-like cell differentiation. , 2004, Biomaterials.

[24]  A. Barbanera,et al.  Custom made bioceramic implants in complex and large cranial reconstruction: a two-year follow-up. , 2012, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[25]  N. Kitchen,et al.  Titanium cranioplasty and the prediction of complications , 2012, British journal of neurosurgery.