Craniofacial reconstruction with poly(methyl methacrylate) customized cranial implants.
BACKGROUND
Secondary cranioplasty with customized craniofacial implants (CCIs) are often used to restore cerebral protection and reverse syndromes of the trephined, and for reconstruction of acquired cranial deformities. The 2 most widely used implant materials are polyetheretherketone and poly(methylmethacrylate) (PMMA). Previous series with CCIs report several major complications, including implant infection leading to removal, extended hospital stays, and surgical revisions. With this in mind, we chose to review our large case series of 22 consecutive PMMA CCI cranioplasties treated by a single craniofacial surgeon.


METHODS
A cohort of 20 consecutive patients receiving 22 PMMA implants during a 2-year period was identified and outcomes reviewed. The mechanism of initial insult, time from craniectomy to cranioplasty, anesthesia time, major and minor postoperative complications, radiation history, and length of follow-up were statistically analyzed.


RESULTS
There were no complications related to infection, hematoma/seroma, or cerebrospinal fluid leak (0/22, 0%). Two patients experienced major complications related to persistent temporal hollowing (PTH) following standard CCI cranioplasty, which required revision surgery with modified implants (2/22, 9%). One minor complication of self-resolving transient diplopia was noted (1/22, 5%).


CONCLUSIONS
In this consecutive series, PMMA CCIs were associated with a very low complication rate, suggesting that PMMA may be a preferred material for CCI fabrication. However, with 10% (2/20) of patients experiencing PTH and dissatisfaction related to asymmetry, future research must be directed at modifying CCI shape, to address the overlying soft-tissue deformity. If successful, this may increase patient satisfaction, prevent PTH, and avoid additional costs of revision surgery.
From the *The University of Illinois College of Medicine, Rockford, Illinois; and Departments of †Plastic and Reconstructive Surgery and ‡Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Gary J
GJ
Huang
Susan
S
Zhong
Srinivas M
SM
Susarla
Edward W
EW
Swanson
Judy
J
Huang
Chad R
CR
Gordon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D015331:Cohort Studies; D003399:Craniotomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012086:Reoperation; D012886:Skull / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D001843:Bone Cements; D019904:Polymethyl Methacrylate