CLINICAL RESEARCH AND DISCUSSION OF MODIFIED CRANIOPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 DUHongpeng , LIZefu , LIMeng , LILijun

Department of Neurosurgery, Affiliated Hospital of Binzhou Medical University, Binzhou Shandong, 256603, P. R. China;

Corresponding author：

DUHongpeng, Email: lddhp@163.com

Keywords：

Decompress craniectomy; Bone chip marker; Cranioplasty; Temporal muscle reconstruction

DOI：

10.7507/1002-1892.20150178

Video：

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Objective To study and design a modified cranioplasty, and to explore the effectiveness so as to reduce the incidence rate of operative complications. Methods A total of 68 patients with craniocerebral trauma or hypertensive cerebral hemorrhage between August 2012 and March 2014 were selected and randomly divided into 2 groups. The standard decompress craniectomy and under-temporal cranioplasty were performed in 32 cases (group A), and several small bone chips were placed under-tempus during decompress craniectomy and then the shape of temporal muscle was designed and the temporal muscle was reconstructed at the attachment sites during cranioplasty in 36 cases (group B). No significant difference was found in gender, age, side of operation, cause of injury, time between injury and decompress craniectomy, and time between postoperation and cranioplasty between 2 groups (P>0.05). Then the postoperative complications were compared between the 2 groups. Results Primary healing of incision was obtained in all patients. The patients were followed up 12 months on average (range, 6-16 months) in 2 groups. The follow complications occurred in group A:4 cases of asymmetric appearance (12.50%), 12 cases of temporal muscle atrophy (37.50%), 6 cases of temporal pain and masticatory atonia (18.75%), 2 cases of epilepsy (6.25%), 9 cases of leakage of cerebrospinal fluid (28.13%), 1 case of cerebral contusion and laceration (3.13%), and 1 case of cerebral hemorrhage (3.13%);temporal muscle atrophy was observed in 2 cases (5.56%) and the rate of complication was significantly lower than that in group A (P<0.05). The symmetrical appearance of the skull and good function were achieved in the other patients having no complication. Conclusion New technique of setting bone chip markers during decompress craniectomy and reconstructing temporal muscle during cranioplasty can reduce the incidence of complications and thus it is an effective surgical procedure.

Citation： DUHongpeng, LIZefu, LIMeng, LILijun. CLINICAL RESEARCH AND DISCUSSION OF MODIFIED CRANIOPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(7): 822-825. doi: 10.7507/1002-1892.20150178 Copy

1.	Bender A,Heulin S,Röhrer S,et al.Early cranioplasty may improve outcome in neurological patients with decompressive craniectomy.Brain Inj,2013,27(9):1073-1079.
2.	Kung WM,Lin FH,Hsiao SH,et al.New reconstructive technologies after decompressive craniectomy in traumatic brain injury:the role of three-dimensional titanium mesh.J Neurotrauma,2012,29(11):2030-2037.
3.	Schuss P,Vatter H,Marquardt G,et al.Cranioplasty after decompressive craniectomy:the effect of timing on postoperative complications.J Neurotrauma,2012,29(6):1090-1095.
4.	Hoffmann B,Sepehrnia A.Taylored implants for alloplastic cranioplasty-clinical and surgical considerations.Acta Neurochir Suppl,2005,93:127-129.
5.	De Bonis P,Frassanito P,Mangiola A,et al.Cranial repair:how complicated is filling a "hole"? J Neurotrauma,2012,29(6):1071-1076.
6.	Wachter D,Reineke K,Behm T,et al.Cranioplasty after decompressive hemicraniectomy:underestimated surgery-associated complications? Clin Neurol Neurosurg,2013,115(8):1293-1297.
7.	游潮,尹浩.加强颅骨成形术的基础与临床研究.中华创伤杂志,2006,22(10):721-724.
8.	宁锦龙,黄剑峰,易椿均,等.颞肌下和颞肌外两种颅骨修补术式的临床疗效对比.中国临床神经外科杂志,2013,18(1):39-41.
9.	林琳,张永辉,昝向阳,等.颞肌外钛网修补颅骨缺损37例.中华神经外科杂志,2010,26(5):461-462.
10.	王辉,刘万荣,魏忠,等.颞肌下和颞肌外两种颅骨修补术式的临床疗效对比.安徽医药,2014,18(2):302-304.
11.	李先松,陈治标.颞肌外和颞肌下颅骨修补术治疗颅骨缺损57例效果观察.实用医院临床杂志,2013,10(6):191-192.
12.	任大斌,童武松,郭义君,等.标准大骨瓣减压术后颞肌下颅骨修补术27例.中华神经外科杂志,2014,30(2):181-182.
13.	张志福,徐国政,杜浩,等.颞肌下钛网修补额颞部颅骨缺损50例.中国临床神经外科杂志,2011,16(4):234-235.
14.	胡礼虹,尹宁,谭爱平,等.数字化成形钛网修补颅骨缺损的效果评价.中国医药指南,2012,10(18):449-450.
15.	Di Rienzo A,Iacoangeli M,Alvaro L,et al.Autologous vascularized dural wrapping for temporalis muscle preservation and reconstruction afterdecompressive craniectomy:report of twenty-five cases.Neurol Med Chir (Tokyo),2013,53(9):590-595.
16.	Oikawa S,Mizuno M,Muraoka S,et al.Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy.Technical note.J Neurosurg,1996,84(2):297-299.
17.	田道锋,邹瑛,陈谦学,等.颞肌的解剖研究及翼点开颅术后颞肌萎缩的防治.中华神经外科杂志,2006,22(4):239-241.
18.	Kitano M,Taneda M.Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery.Neurosurgery,2004,54(3):653-660.
19.	杨杰,吴俊波,肖锋,等.颞肌复位在标准大骨瓣减压术后颅骨缺损修补中的应用研究.中华神经医学杂志,2014,13(10):1048-1052.

1. Bender A,Heulin S,Röhrer S,et al.Early cranioplasty may improve outcome in neurological patients with decompressive craniectomy.Brain Inj,2013,27(9):1073-1079.
2. Kung WM,Lin FH,Hsiao SH,et al.New reconstructive technologies after decompressive craniectomy in traumatic brain injury:the role of three-dimensional titanium mesh.J Neurotrauma,2012,29(11):2030-2037.
3. Schuss P,Vatter H,Marquardt G,et al.Cranioplasty after decompressive craniectomy:the effect of timing on postoperative complications.J Neurotrauma,2012,29(6):1090-1095.
4. Hoffmann B,Sepehrnia A.Taylored implants for alloplastic cranioplasty-clinical and surgical considerations.Acta Neurochir Suppl,2005,93:127-129.
5. De Bonis P,Frassanito P,Mangiola A,et al.Cranial repair:how complicated is filling a "hole"? J Neurotrauma,2012,29(6):1071-1076.
6. Wachter D,Reineke K,Behm T,et al.Cranioplasty after decompressive hemicraniectomy:underestimated surgery-associated complications? Clin Neurol Neurosurg,2013,115(8):1293-1297.
7. 游潮,尹浩.加强颅骨成形术的基础与临床研究.中华创伤杂志,2006,22(10):721-724.
8. 宁锦龙,黄剑峰,易椿均,等.颞肌下和颞肌外两种颅骨修补术式的临床疗效对比.中国临床神经外科杂志,2013,18(1):39-41.
9. 林琳,张永辉,昝向阳,等.颞肌外钛网修补颅骨缺损37例.中华神经外科杂志,2010,26(5):461-462.
10. 王辉,刘万荣,魏忠,等.颞肌下和颞肌外两种颅骨修补术式的临床疗效对比.安徽医药,2014,18(2):302-304.
11. 李先松,陈治标.颞肌外和颞肌下颅骨修补术治疗颅骨缺损57例效果观察.实用医院临床杂志,2013,10(6):191-192.
12. 任大斌,童武松,郭义君,等.标准大骨瓣减压术后颞肌下颅骨修补术27例.中华神经外科杂志,2014,30(2):181-182.
13. 张志福,徐国政,杜浩,等.颞肌下钛网修补额颞部颅骨缺损50例.中国临床神经外科杂志,2011,16(4):234-235.
14. 胡礼虹,尹宁,谭爱平,等.数字化成形钛网修补颅骨缺损的效果评价.中国医药指南,2012,10(18):449-450.
15. Di Rienzo A,Iacoangeli M,Alvaro L,et al.Autologous vascularized dural wrapping for temporalis muscle preservation and reconstruction afterdecompressive craniectomy:report of twenty-five cases.Neurol Med Chir (Tokyo),2013,53(9):590-595.
16. Oikawa S,Mizuno M,Muraoka S,et al.Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy.Technical note.J Neurosurg,1996,84(2):297-299.
17. 田道锋,邹瑛,陈谦学,等.颞肌的解剖研究及翼点开颅术后颞肌萎缩的防治.中华神经外科杂志,2006,22(4):239-241.
18. Kitano M,Taneda M.Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery.Neurosurgery,2004,54(3):653-660.
19. 杨杰,吴俊波,肖锋,等.颞肌复位在标准大骨瓣减压术后颅骨缺损修补中的应用研究.中华神经医学杂志,2014,13(10):1048-1052.

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CLINICAL RESEARCH AND DISCUSSION OF MODIFIED CRANIOPLASTY

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