Fixation of silicon-polyester fiber network on skull defect was usually difficult to handle and the fixation was unstable. In order to solve these problems, NiTi shape-memory alloy cramp was adopted and 101 patients with skull defects were selected for this clinical trial. Among them, there were 79 males and 22 females, and the age ranged from 12-55 years old. The area of skull defect ranged from 3 cm x 4 cm to 10 cm x 16 cm. All of these patients received repairing of the skull defects by silicon-polyester fiber network which was fixed by NiTi memory alloy cramps. After operation, there was no complication. One hundred patients were followed up for 1-8 years, in which 97 cases returned to their normal work, and only 2 cases had a transient dysfunction of frontal muscle for 2 months. In addition, There were no loosening of the cramps, displacement of plastic network and malignant degeneration. The NiTi shape-memory alloy cramps had the following advantages: 1. Simple operative procedure; 2. Rigid fixation; 3. Mild postoperative tissue reaction; 4. Few postoperative complication; 5. Favorable effect of skull repair; 6. No interference with CT and MRI image; 7. No carcinogenicity.
ObjectiveTo investigate the technique and the effectiveness of digital three-dimensional (3-D) titanium mesh in repairing skull defect under the temporalis and reconstructing temporal muscle attachment points. MethodsBetween January 2009 and December 2012, 58 patients with skull defect after decompressive craniectomy at the frontal temporal region were treated. Of 58 patients, 33 were male and 25 were female, aged 17-62 years (mean, 36.2 years). The disease duration was 15 weeks to 25 months (mean, 5.8 months). The size of skull defect ranged from 8 cm×6 cm to 15 cm×12 cm. The patients underwent skull impairment patch surgery with digital 3-D titanium mesh and reconstruction of the temporal muscle attachment points at titanium mesh temporal corresponding position. ResultsThe operation time was 60-100 minutes (mean, 87 minutes). After operation, 2 cases had slight red swelling with little exudation at skin incision margin, which was cured after symptomatic treatment; 2 cases had symptom of headache, which disappeared after incision healing; primary healing of incision was obtained in the other patients. Fifty-eight patients were followed up 6-24 months (mean, 16 months). The patients were satisfied with shaping, and had no chewing pain. Head CT after operation showed good fixation of titanium mesh and titanium nail, and satisfactory skull shape symmetry; no postoperative complication of subcutaneous effusion, intracranial bleeding, titanium mesh loosening, or titanium mesh exposure occurred. ConclusionThe surgery technique of digital 3-D titanium mesh to repair skull defect in frontal temporal region and to reconstruct temporal muscle attachment points at the corresponding position of titanium mesh, basically can obtain anatomical reduction of the skull, frontal temporal, and each layer of scalp. It has the advantages of less complication, less titanium nail, and satisfactory shape.
ObjectiveTo study and design a modified cranioplasty, and to explore the effectiveness so as to reduce the incidence rate of operative complications. MethodsA 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. ResultsPrimary 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. ConclusionNew 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.
Objective To investigate the value of bridged dural suspension for cranioplasty by using three- dimensional moulding titanium mesh. Methods A retrospective analysis was made on the clinical data of 156 patients with skull defects, who underwent cranioplasty using three-dimensional moulding titanium mesh between April 2012 and October 2015. Bridged dural suspension was performed in 73 patients (bridging group) and routine cross mesh dural suspension in 83 patients (routine group). There was no significant difference in gender, age, and causes, duration, and area of skull defects between 2 groups (P > 0.05), and they were comparable. The operation time, hospitalization time, and postoperative complication were recorded for analysis. Results The operation time was (86.7±13.5) minutes in bridging group and was (84.3±16.3) minutes in routine group, showing no significant difference (t=1.061, P=0.290); but hospitalization time of bridging group [(16.8±2.7) days] was significantly shorter than that of routine group [(18.7±5.7) days] (t=-2.661, P=0.009). Postoperative complications occurred in 16 patients of routine group (19.3%), including epidural hydrops in 13 cases, epidural hematoma in 2 cases, and epidural infection in 1 case, while epidural hydrops occurred in 4 cases of bridging group (5.5%). There was significant difference in complication rate between 2 groups (χ2=6.616, P=0.010). All patients were followed up 5-46 months (mean, 25.2 months). The satisfactory cosmetic results of the skull were obtained, and CT images showed good coverage of defect. Conclusion Bridged dural suspension for cranioplasty is more simple and effective than routine cross mesh suspension, and it is beneficial to reduction of postoperative complications.
ObjectiveTo explore the related risk factors of epilepsy after traumatic skull defect repair.MethodsThe clinical data of 72 cases patients underwent cranial three-dimensional titanium mesh repair in Neurosurgery Department of Sichuan Baoshihua Hospital from February 2010 to December 2017 were collected and followed up for 6 months, retrospectively analysed the causes and operation problems of secondary epilepsy after repair.Results21 casese (29.2%) among the 72 cases patients underwent cranioplasty were found with secondary epilepsy. Univariate analysis showed that the rate of secondary epilepsy in patients with softening lesion of gray matter, no formal antiepileptic treatment after the first operation, suspension of dural during operation and repair time of the trauma >6 months was significantly higher than that in patients without secondary epilepsy (P<0.05). Multivariate Logistic regression was used to correct the results, showing that softening lesion in the gray matter [OR=8.425, 95% CI (2.541, 27.934), P<0.001)], no formal antiepileptic treatment after the first operation [OR=0.160, 95% CI (0.050, 0.518), P=0.002], intra-operative suspended dural [OR=13.306; 95% CI (3.769, 46.976), P<0.001] and repair time of trauma >6 months [OR=6.205, 95% CI (1.705, 22.583], P=0.006] were independent risk factors of secondary epilepsy.ConclusionAfter decompression of bone flap, regular antiepileptic therapy, shortening repair time, and proper peroperative management can reduce the incidence of postoperative epilepsy.
Objective To explore the effectiveness of two-stage operation on free latissimus dorsi myocutaneous flap transplantation and skull contour reconstruction in the treatment of head titanium mesh exposure complicated with soft tissue infection. Methods Between January 2015 and December 2021, 13 patients with head titanium mesh exposure complicated with soft tissue infection were admitted. There were 9 males and 4 females with a mean age of 42.9 years (range, 23-64 years). The duration of titanium mesh exposure was 22-609 days (median, 102 days). The wound site located at the frontal part in 3 cases, the parietal part in 1 case, the occipital part in 2 cases, the frontal-parietal part in 1 case, the temporal-parietal part in 4 cases, and the frontotemporal part in 2 cases. The titanium mesh had been taken out in 5 patients before admission, leaving skull defect and shape collapse, with signs of infection. The bacterial culture was positive in 7 cases and negative in 6 cases. The imaging examination revealed that the size of the skull defect ranged from 6 cm×5 cm to 21 cm×17 cm and the scalp defect ranged from 1 cm×1 cm to 15 cm×10 cm. The soft tissue infection did not reach dura in 5 cases, reached dura in 6 cases, and reached frontal sinus in 2 cases. The two-stage surgical protocol was used in all patients. In the first-stage operation, the latissimus dorsi myocutaneous flap was designed to repair the skull and scalp defects after removing the titanium mesh and thorough debridement. The size of muscle flap ranged from 13.5 cm×4.0 cm to 21.0 cm×17.0 cm, and the skin flap ranged from 7.0 cm×4.0 cm to 15.0 cm×10.0 cm. After the flap survived and stabilized, the second-stage operation was performed. The titanium mesh was implanted to reconstruct the skull contour. The size of titanium mesh ranged from 7.0 cm×6.0 cm to 21.5 cm×17.5 cm. The interval between the first- and second-stage operations was 3.7-17.8 months, with an average of 11.4 months. The survival of the skin flap, the appearance of the head, and the presence of re-exposed titanium mesh and infection were observed after operation. Results At the first-stage operation, venous embolism occurred in 1 case, and no obvious abnormality was observed after treatment. All the flaps survived and the incisions healed by first intention. Besides, the incisions of the second-stage operation healed by first intention. All patients were followed up 1-96 months (median, 14 months). During follow-up, no exposure to titanium mesh, infection, or other complications occurred. The appearance satisfaction rate of the patients was 92.31% (11/13). There was no significant difference in the skull contour between the affected side and the healthy side in all patients. Conclusion For the head titanium mesh exposure with soft tissue infection, the application of two-stage operation on free latissimus dorsi myocutaneous flap transplantation and skull contour reconstruction can reduce the risks of implant exposure and infection again by increasing the thickness of the scalp and blood supply, filling the wound cavity, and obtain good effectiveness.