gms | German Medical Science

Objective: Decompressive craniectomy (DC) is an effective procedure to treat elevated intracranial pressure conditions but does require secondary cranioplasty in the majority of cases. However, reimplantation of the autologous bone flap after cryoconservation is associated with a high number of osteolysis, therefore, alloplastic cvranioplasty is increasingly used. Numerous materials have been investigated to meet demanded key features, such as stability, surgical applicability, and biocompatibility. But, alloplastic cranioplasty is still associated with a high number of implant infections and wound healing complications. Therefore, we aimed to evaluate the feasibility and safety of a recently introduced patient-specific titanium-enhancedcalcium-phosphate CAD implant with a supposedly higher biocompatibility.

Methods: The medical records of all patients who underwent DC between January 1st, 2020 and January 31st, 2021 were reviewed. Demographic, clinical, and diagnostic data before and after the cranioplasty were collected. Descriptive statistical analysis was performed.

Results: DC was performed in 32 consecutive patients, due to aSAH (43.8%), malignant MCA infarction (25%), TBI (12.5%) or ICH (18.8%). Twenty of these patients (62.5% female) with a mean age of 52±17 years received a patient-specific calcium-phosphate implant for cranioplasty. The mean time from DC to CP was 120.45±71.5 days. Mean follow-up time from CP was 340.4±125.5 days. Overall, 5 procedure-related complications occurred; 2 epidural hematomas not necessitating revision surgery, 2 patients suffered from seizures, and 1 patient necessitated delayed revision surgery 481 days after CP with implant explantation due to skin atrophy developed by a pathological head posture and the resulting soft tissue pressure. No bacterial infection was detected on this implant, no other infections of the surgical site or the implant occurred. Routine CT imaging evaluation was not hampered by the titanium implant, no imaging artifacts occurred.

Conclusion: In the present study, a patient-specific titanium-enhanced biocompatible calcium-phosphate implant was used for CP in 20 consecutive patients. The absence of a surgical site infection proves the feasibility and safety of this biocompatible implant material. Furthermore, postoperative follow-up imaging is possible without limitations. Thus, these implants offer an alternative to titanium or PMMA cranioplasty and may reduce the risk of surgical site complications.