title: Cranioplasty using polymethyl methacrylate prostheses.
abstract: In this retrospective study we attempted to assess the clinical performance of prefabricated polymethyl methacrylate (PMMA) prostheses and to determine whether they outperform intra-operatively moulded PMMA prostheses in reducing operating time, blood loss and surgical complications in elective delayed cranioplasty operations, after decompressive craniectomy, to repair large (> 100 cm2) cranial defects. Patients (n=131) were divided into three groups according to the cranioplasty technique used. Group 1 patients received fresh frozen autograft bone that had been removed at the craniectomy and refrigerated at -80 degrees C. Group 2 included patients whose PMMA prosthesis was moulded intra-operatively. Group 3 patients received a custom-made prefabricated PMMA prosthesis manufactured using computer-aided design/computer-aided manufacturing (CAD/CAM). Group 2 patients required significantly more operating time than both group 1 (p<0.001) and group 3 (p<0.001) patients, but operating time did not differ significantly between groups 1 and 3 (p>0.05). Mean intra-operative blood loss was significantly higher in group 2 than in group 1 (p=0.015) but did not differ significantly between group 1 and group 3 (p>0.05). The infection rate associated with prefabricated PMMA prostheses was lower than that for intra-operatively moulded PMMA prostheses and was comparable to that for autograft bone flaps. A CAD/CAM PMMA prosthesis is an excellent alternative when no autogenous bone graft harvested during craniectomy is available.
authors.affiliation: Department of Neurosurgery, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Sai-Cheung
authors.initials: SC
authors.lastname: Lee
authors.forename: Chieh-Tsai
authors.initials: CT
authors.lastname: Wu
authors.forename: Shih-Tseng
authors.initials: ST
authors.lastname: Lee
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019904:Polymethyl Methacrylate