title: Interval cranioplasty with patient-specific implants and autogenous bone grafts--success and cost analysis.
abstract: Different options exist for the reconstruction of craniectomy defects following interval cranioplasty. The standard procedure is still based on the re-implantation of autogenous bone specimen which can be stored in the abdominal wall or be cryopreserved. Alternatively patient-specific implants (PSIs) can be used. We conducted a retrospective study based on 50 consecutive patients with skull bone defects of 100 cm(2) or more being operated on by the same team of surgeons. Thirty-three patients agreed to take part in the study. Seventeen patients who underwent reconstruction with PSIs (titanium and polyether ether ketone, PEEK) (follow-up, 43 months [range, 3-93]) were compared with 16 control subjects who had autogenous bone grafts re-implanted (follow-up, 32 months [range, 5-92]). Criteria analyzed were the success and complication rates, operation time, duration of hospitalization and the treatment costs. Complication rate and the rate of reoperation were significantly lower, and the hospital stay was shorter in the PSI group. The treatment costs for reconstruction with autogenous bone were considerably lower than skull bone reconstruction based on PSIs (average costs: 10849.91 €/patient versus 15532.08 €/patient with PSI). Due to biological reasons some of the autogenous bone implants fail due to infection and resorption and the patients have to undergo another operation with implantation of a PSI in a secondary attempt. For those patients the highest overall treatment costs must be calculated (average costs: 26086.06 €/patient with secondary stage PSI versus 15532.08 €/patient with primary stage PSI).
  
  
  CONCLUSIONS
  High success rates and reliability of PSIs may change the treatment strategy in patients undergoing interval cranioplasty.
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, P. Debeyelaan 25, AZ 6202 Maastricht, The Netherlands.
authors.forename: Bernd
authors.initials: B
authors.lastname: Lethaus
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, P. Debeyelaan 25, AZ 6202 Maastricht, The Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: Bloebaum
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, P. Debeyelaan 25, AZ 6202 Maastricht, The Netherlands.
authors.forename: David
authors.initials: D
authors.lastname: Koper
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Center, P. Debeyelaan 25, AZ 6202 Maastricht, The Netherlands.
authors.forename: Mariel
authors.initials: M
authors.lastname: Poort-Ter Laak
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, P. Debeyelaan 25, AZ 6202 Maastricht, The Netherlands. Electronic address: peter.kessler@mumc.nl.
authors.forename: Peter
authors.initials: P
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064592:Autografts / Q000637:transplantation*; D001577:Benzophenones; D001672:Biocompatible Materials / Q000737:chemistry*; D016025:Bone Transplantation / Q000379:methods*; D003365:Costs and Cost Analysis; D003399:Craniotomy / Q000379:methods*; D015925:Cryopreservation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007659:Ketones / Q000737:chemistry; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011092:Polyethylene Glycols / Q000737:chemistry; D011108:Polymers; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D014021:Tissue Preservation / Q000379:methods; D014025:Titanium / Q000737:chemistry; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001577:Benzophenones; D001672:Biocompatible Materials; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols; D014025:Titanium
keywords: Autogenous bone grafts; Craniectomy; Cranioplasty; Patient specific implant; Treatment costs