title: Custom made bioceramic implants in complex and large cranial reconstruction: a two-year follow-up.
abstract: BACKGROUND
  Large cranial defects still represent a challenge in neurosurgery. Currently different biomaterials are available for cranial reconstruction including titanium, acrylic mesh and different types of calcium phosphate-based bone grafts. The goal of surgery is a perfect fit of the implant without infection and absorption, and a good aesthetic result. This paper describes a surgical method for cranioplasty, using a customised porous hydroxyapatite (HA) prosthesis.
  
  
  METHODS
  Sixty patients treated surgically with a customised porous-HA prosthesis for large cranial defects, were followed retrospectively. A two-year follow-up was carried out with periodic visits and CT scans. Safety (the incidence of adverse events and fractures of the implant) and clinical performance (biological and cosmetic results) were evaluated.
  
  
  RESULTS
  Fifty one patients were followed-up, no rejection occurred and only one case of infection was recorded. Five patients had minor surgery-related complications, and no spontaneous implant fractures or mobilisation were reported. Three patients exhibited implant fractures as a result of trauma and all healed spontaneously. All patients showed a satisfactory clinical outcome with good cosmetic appearance in the early postoperative period and after a long-term follow-up.
  
  
  CONCLUSIONS
  Cranioplasty performed with a customised porous-HA prosthesis gave a positive outcome, showing it to be an appropriate technique for use in large and complex cranial reconstruction.
authors.affiliation: Division of Neurotraumatology, Bufalini Hospital, via Ghirotti 286, Cesena, Italy. g.staffa@ausl.ra.it
authors.forename: Guido
authors.initials: G
authors.lastname: Staffa
authors.forename: Andrea
authors.initials: A
authors.lastname: Barbanera
authors.forename: Andrea
authors.initials: A
authors.lastname: Faiola
authors.forename: Marco
authors.initials: M
authors.lastname: Fricia
authors.forename: Paolo
authors.initials: P
authors.lastname: Limoni
authors.forename: Ruggero
authors.initials: R
authors.lastname: Mottaran
authors.forename: Bruno
authors.initials: B
authors.lastname: Zanotti
authors.forename: Roberto
authors.initials: R
authors.lastname: Stefini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000737:chemistry*; D002516:Ceramics / Q000737:chemistry*; D017076:Computer-Aided Design; D003399:Craniotomy / Q000379:methods*; D017886:Durapatite / Q000737:chemistry*; D004869:Equipment Safety; D004954:Esthetics; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000601:surgery; D006801:Humans; D006882:Hydroxyapatites / Q000737:chemistry; D021621:Imaging, Three-Dimensional / Q000379:methods; D008875:Middle Aged; D016348:Osseointegration / Q000502:physiology; D010294:Parietal Bone / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D013701:Temporal Bone / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D006882:Hydroxyapatites; C094280:hydroxyapatite-tricalciumphosphate composite; D017886:Durapatite