title: Surgical results of cranioplasty with a polymethylmethacrylate customized cranial implant in pediatric patients: a single-center experience.
abstract: OBJECTIVE Cranioplasty is a reconstructive procedure used to restore skull anatomy and repair skull defects. Optimal skull reconstruction is a challenge for neurosurgeons, and the strategy used to achieve the best result remains a topic of debate, especially in pediatric patients for whom the continuing skull growth makes the choice of material more difficult. When the native bone flap, which is universally accepted as the preferred option in pediatric patients, is unavailable, the authors' choice of prosthetic material is a polymethylmethacrylate (PMMA) implant designed using a custom-made technique. In this paper the authors present the results of their clinical series of 12 custom-made PMMA implants in pediatric patients. METHODS A retrospective study of the patients who had undergone cranioplasty at Gaslini Children's Hospital between 2006 and 2013 was conducted. A total of 12 consecutive cranioplasties in 12 patients was reviewed, in which a patient-specific PMMA implant was manufactured using a virtual 3D model and then transformed into a physical model using selective laser sintering or 3D printing. All patients or parents were administered a questionnaire to assess how the patient/parent judged the aesthetic result. RESULTS Patient age at craniectomy ranged from 5 months to 12.5 years, with a mean age of 84.33 months at cranioplasty. The mean extension of the custom-made plastic was 56.83 cm(2). The mean time between craniectomy and cranioplasty was 9.25 months. The mean follow-up duration was 55.7 months. No major complications were recorded; 3 patients experienced minor/moderate complications (prosthesis dislocation, granuloma formation, and fluid collection). CONCLUSIONS In this patient series, PMMA resulted in an extremely low complication rate and the custom-made technique was associated with an excellent grade of patient or parent satisfaction on long-term follow up.
authors.affiliation: Department of Neurosurgery, San Martino - IST University Hospital (IRCCS), Genoa;|Department of Neuroscience, University of Turin, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Fiaschi
authors.affiliation: Department of Pediatric Neurosurgery, Istituto Giannina Gaslini, Genoa;
authors.forename: Marco
authors.initials: M
authors.lastname: Pavanello
authors.affiliation: Department of Pediatric Neurosurgery, Istituto Giannina Gaslini, Genoa;
authors.forename: Alessia
authors.initials: A
authors.lastname: Imperato
authors.affiliation: Department of Neurosurgery, ICCS Hospital, Milan;
authors.forename: Villiam
authors.initials: V
authors.lastname: Dallolio
authors.affiliation: Department of Pediatric Neurosurgery, Istituto Giannina Gaslini, Genoa;|University of Genoa; and.
authors.forename: Andrea
authors.initials: A
authors.lastname: Accogli
authors.affiliation: Department of Pediatric Neurosurgery, Istituto Giannina Gaslini, Genoa;
authors.forename: Valeria
authors.initials: V
authors.lastname: Capra
authors.affiliation: Department of Pediatric Neurosurgery, Istituto Giannina Gaslini, Genoa;
authors.forename: Alessandro
authors.initials: A
authors.lastname: Consales
authors.affiliation: Department of Pediatric Neurosurgery, Istituto Giannina Gaslini, Genoa;
authors.forename: Armando
authors.initials: A
authors.lastname: Cama
authors.affiliation: Department of Pediatric Neurosurgery, Istituto Giannina Gaslini, Genoa;
authors.forename: Gianluca
authors.initials: G
authors.lastname: Piatelli
mesh_terms: D000293:Adolescent; D001165:Arteriovenous Malformations / Q000601:surgery; D001843:Bone Cements / Q000627:therapeutic use*; D000070642:Brain Injuries, Traumatic / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D059041:Plagiocephaly / Q000601:surgery; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: PMMA = polymethylmethacrylate; cranioplasty; custom-made technique; pediatric reconstructive surgery; polymethylmethacrylate