[Fracture of macroporous hydroxyapatite prosthesis].
Different prosthesis implants are offered to perform a cranioplasty after a decompressive craniectomy when autologous bone graft cannot be used. The authors report the case of a 25-year-old man who benefited a unilateral decompressive craniectomy after a severe head trauma. Seven months later, a cranioplasty using custom macroporous hydroxyapatite prosthesis was performed. The postoperative course was marked by a generalized seizure leading to a traumatic head injury. The CT-scan showed a comminutive fracture of the prosthesis and an extradural hematoma. The patient underwent a removal of the fractured prosthesis and an evacuation of the extradural clot. The postoperative course was uneventful with a Glasgow outcome scale score at 5. A second cranioplasty using a polyether ether ketone (PEEK) implant was performed. Among cranioplasty prosthesis solutions, hydroxyapatite implants seem to have similar property to the bone. However, its weak mechanic resistance is an actual problem in patients susceptible to present generalized seizures with consecutive head impact. Hence, in patients with decompressive craniectomy who are exposed to potential brain injury, we favor the use of more resistant implant as PEEK prosthesis.
Service de neurochirurgie, hôpital la Timone Adulte, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France. agona.adetchessi@ap-hm.fr
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D000063:Accidents, Traffic; D000328:Adult; D001577:Benzophenones; D001672:Biocompatible Materials / Q000737:chemistry; D018786:Bone Substitutes / Q000737:chemistry / Q000627:therapeutic use*; D001929:Brain Edema / Q000209:etiology; D001930:Brain Injuries / Q000150:complications / Q000601:surgery; D056424:Decompressive Craniectomy / Q000379:methods*; D017886:Durapatite / Q000737:chemistry*; D004829:Epilepsy, Generalized / Q000209:etiology; D005624:Frontal Bone / Q000293:injuries / Q000601:surgery; D020199:Hematoma, Subdural, Acute / Q000209:etiology; D006801:Humans; D007659:Ketones; D008297:Male; D009049:Motorcycles; D011092:Polyethylene Glycols; D011108:Polymers; D016062:Porosity; D011183:Postoperative Complications / Q000209:etiology; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012887:Skull Fractures / Q000601:surgery*; D013314:Stress, Mechanical
D001577:Benzophenones; D001672:Biocompatible Materials; D018786:Bone Substitutes; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols; D017886:Durapatite