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.