Management of Failed Cranioplasty.
OBJECTIVE
Failed cranioplasty attempts may lead to numerous complications in a broad spectrum including cosmetic problems, infection, neurological deterioration and even death. Selection of the most appropriate surgical technique for second and further surgical attempts for these patients still remains a debate. We aimed to share our experience and technical pitfalls on management of failed cranioplasty, particularly for patients with large cranial defects.


METHODS
A retrospective data analysis of cranioplasty cases in our series was performed including the time period between 2002 and 2012. Patients required recurrent cranioplasty were analyzed in detail.


RESULTS
Totally, 101 patients underwent cranioplasty for bony defect. Of 101 patients, eleven required a revision surgery due to infection or spontaneous resorption of the bone flap. All patients underwent revision cranioplasty with pre-surgical plaster cast mold technique modified from previous studies and/or tissue expansion technique. Polymethyl-metacrylate (PMMA) was used as substitute for reconstructions. Mean follow-up was 36 months. Two out of eleven cases (18.1%) developed major complications, which led to further revision. At the end, a satisfactory reconstruction was achieved for all patients.


CONCLUSIONS
Our modified molded plaster cast technique is a safe and cost-effective approach for the revision of failed cranioplasty. We believe that the tissue expanding techniques have also great contribution to achieve successful results.
Memorial Health Group, Department of Neurosurgery, Istanbul, Turkey.
Ramazan
R
Sari
Mehmet
M
Tonge
Fatih Han
FH
Bolukbasi
Mustafa
M
Onoz
Ozdil
O
Baskan
Gokalp
G
Silav
Ilhan
I
Elmaci
D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D017211:Treatment Failure; D055815:Young Adult