Skip to main content
Erschienen in: Child's Nervous System 2/2017

24.12.2016 | Original Paper

Hydroxyapatite ceramic implants for cranioplasty in children: a single-center experience

verfasst von: Laura Zaccaria, Sasha Job Tharakan, Stefan Altermatt

Erschienen in: Child's Nervous System | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The use of hydroxyapatite ceramic (HAC) implants for the treatment of skull defects in pediatric patients started 2010 at our institution. Ceramic implants facilitate osteoblast migration and therefore optimize osteointegration with the host bone. The purpose of this study is to report a single-center experience with this treatment modality.

Methods

A retrospective review of all patients from July 2010 through June 2014 undergoing a cranioplasty using hydroxyapatite ceramic implant and managed at a single institution was performed. Indication for cranioplasty, the hospital course, and follow-up were reviewed. Bone density was measured in Hounsfield Units (HU) and osteointegration was calculated using Mimics Software® (Mimics Innovation Suite v17.0 Medical, Materialize, Leuven, Belgium).

Results

Over the 4-year period, six patients met criteria for the study. Five patients had an osteointegration of nearly 100%. One patient had an incomplete osteointegration with a total bone-implant contact area of 69%. The mean bone density was 2800 HU (2300–3000 HU). Bone density alone is estimated to have a Hounsfield value between 400 and 2000 HU depending on the body region and bone quality. There were no major complications, and the patients were highly satisfied with the esthetical result.

Conclusion

Hydroxyapatite ceramic implants for cranioplasty in pediatric patients are a good choice for different indications. The implants show excellent osteointegration and esthetical results.
Literatur
1.
Zurück zum Zitat Staffa G, Nataloni A, Compagnone C, Servadei F (2007) Custom made cranioplasty prostheses in porous hydroxy-apatite using 3D design techniques: 7 years experience in 25 patients. Acta Neurochir 149:161–170CrossRefPubMed Staffa G, Nataloni A, Compagnone C, Servadei F (2007) Custom made cranioplasty prostheses in porous hydroxy-apatite using 3D design techniques: 7 years experience in 25 patients. Acta Neurochir 149:161–170CrossRefPubMed
2.
Zurück zum Zitat Staffa G, Barbanera A, Faiola A, Fricia M, Limoni P, Mottaran R, Zanotti B, Stefini R (2012) Custom made bioceramic implants in complex and large cranial reconstruction: a two-year follow-up. J Craniomaxillofac Surg 40:e65–e70CrossRefPubMed Staffa G, Barbanera A, Faiola A, Fricia M, Limoni P, Mottaran R, Zanotti B, Stefini R (2012) Custom made bioceramic implants in complex and large cranial reconstruction: a two-year follow-up. J Craniomaxillofac Surg 40:e65–e70CrossRefPubMed
3.
Zurück zum Zitat Martini L, Staffa G, Giavaresi G, Salamanna F, Parrilli A, Serchi E, Pressato D, Arcangeli E, Fini M (2012) Long-term results following cranial hydroxyapatite prosthesis implantation in a large skull defect model. Plast Reconstr Surg 129:625eCrossRefPubMed Martini L, Staffa G, Giavaresi G, Salamanna F, Parrilli A, Serchi E, Pressato D, Arcangeli E, Fini M (2012) Long-term results following cranial hydroxyapatite prosthesis implantation in a large skull defect model. Plast Reconstr Surg 129:625eCrossRefPubMed
4.
Zurück zum Zitat Shah AM, Jung H, Skirboll S (2014) Materials used in cranioplasty: a history and analysis. Neurosurg Focus 36(4):E19CrossRefPubMed Shah AM, Jung H, Skirboll S (2014) Materials used in cranioplasty: a history and analysis. Neurosurg Focus 36(4):E19CrossRefPubMed
5.
Zurück zum Zitat Martin KD, Franz B, Kirsch M, Polanski W, Von der Hagen M, Schackert G, Sobottka SB (2014) Autologous bone flap cranioplasty following decompressive craniectomy is combined with a high complication rate in pediatric traumatic brain injury patients. Acta Neurochir 156:813–824CrossRefPubMed Martin KD, Franz B, Kirsch M, Polanski W, Von der Hagen M, Schackert G, Sobottka SB (2014) Autologous bone flap cranioplasty following decompressive craniectomy is combined with a high complication rate in pediatric traumatic brain injury patients. Acta Neurochir 156:813–824CrossRefPubMed
6.
Zurück zum Zitat Lemée JM, Petit D, Splingard M, Menei P (2013) Autologous bone flap versus hydroxyapatite prosthesis in first intention in secondary cranioplasty after decompressive craniectomy: a French medico-economical study. Neurochirurgie 59:60–63CrossRefPubMed Lemée JM, Petit D, Splingard M, Menei P (2013) Autologous bone flap versus hydroxyapatite prosthesis in first intention in secondary cranioplasty after decompressive craniectomy: a French medico-economical study. Neurochirurgie 59:60–63CrossRefPubMed
7.
Zurück zum Zitat El Ghoul W, Harrisson S, Belli A (2014) Autologous cranioplasty following decompressive craniectomy in the trauma setting. Br J Neurosurg Early online: 1–6 El Ghoul W, Harrisson S, Belli A (2014) Autologous cranioplasty following decompressive craniectomy in the trauma setting. Br J Neurosurg Early online: 1–6
8.
Zurück zum Zitat Frassanito P, Tamburrini G, Massimi L, Di Rocco C, Nataloni A, Fabbri G, Caldarelli M (2015) Post-marketing surveillance of CustomBone Service implanted in children under 7 years old. Acta Neurochir 157:115–121CrossRefPubMed Frassanito P, Tamburrini G, Massimi L, Di Rocco C, Nataloni A, Fabbri G, Caldarelli M (2015) Post-marketing surveillance of CustomBone Service implanted in children under 7 years old. Acta Neurochir 157:115–121CrossRefPubMed
9.
Zurück zum Zitat Frassanito P, Massimi L, Calderelli M, Tamburrini, Di Rocco C (2012) Complications of delayed cranial repair after decompressive craniectomy in children less than 1 year old. Acta Neurochir 154:927–933CrossRefPubMed Frassanito P, Massimi L, Calderelli M, Tamburrini, Di Rocco C (2012) Complications of delayed cranial repair after decompressive craniectomy in children less than 1 year old. Acta Neurochir 154:927–933CrossRefPubMed
10.
Zurück zum Zitat Stefini R, Esposito G, Zanotti B, Iaccarino C, Fontanella MM, Servadei F (2013) Use of “custom made” porous hydroxyapatite implants for cranioplasty: postoperative analysis of complications in 1549 patients. Surg Neurol Int 4:12CrossRefPubMedPubMedCentral Stefini R, Esposito G, Zanotti B, Iaccarino C, Fontanella MM, Servadei F (2013) Use of “custom made” porous hydroxyapatite implants for cranioplasty: postoperative analysis of complications in 1549 patients. Surg Neurol Int 4:12CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Della Puppa A, Mottaran R, Scienza R (2010) Image-guided cranial osteoma resection and bioceramic porous hydroxyapatite custom-made reconstruction in a one-step surgical procedure. Technical notes and illustrative case. Acta Neurochir 152:155–159CrossRefPubMed Della Puppa A, Mottaran R, Scienza R (2010) Image-guided cranial osteoma resection and bioceramic porous hydroxyapatite custom-made reconstruction in a one-step surgical procedure. Technical notes and illustrative case. Acta Neurochir 152:155–159CrossRefPubMed
12.
Zurück zum Zitat Appelboom G, Zoller SD, Piazza MA, Szpalski C, Bruce SS, McDowell MM, Vaughan KA, Zacharia BE, Hickman Z, D’Ambrosio A, Feldstein NA, Anderson RCE (2011) Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery. Neurosurg Focus 31(5):E5CrossRefPubMed Appelboom G, Zoller SD, Piazza MA, Szpalski C, Bruce SS, McDowell MM, Vaughan KA, Zacharia BE, Hickman Z, D’Ambrosio A, Feldstein NA, Anderson RCE (2011) Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery. Neurosurg Focus 31(5):E5CrossRefPubMed
13.
Zurück zum Zitat Grant GA, Jolley M, Ellenbogen RG, Roberts TS, Gruss JR, Loeser JD (2004) Failure of autologous bone-assisted cranioplasty following decompressive craniectomy in children and adolescents. J Neurosurg 100(Pediatrics 2):163–168PubMed Grant GA, Jolley M, Ellenbogen RG, Roberts TS, Gruss JR, Loeser JD (2004) Failure of autologous bone-assisted cranioplasty following decompressive craniectomy in children and adolescents. J Neurosurg 100(Pediatrics 2):163–168PubMed
14.
Zurück zum Zitat Brevi BC, Magri AS, Toma L, Sesenna E (2010) Cranioplasty for repair of a large bone defect with autologous and homologous bone in children. J Ped Surg 45:E17–E20CrossRef Brevi BC, Magri AS, Toma L, Sesenna E (2010) Cranioplasty for repair of a large bone defect with autologous and homologous bone in children. J Ped Surg 45:E17–E20CrossRef
15.
Zurück zum Zitat Pechmann A, Anastasopoulos C, Korinthenberg R, Van Velthoven-Wurster V, Kirschner J (2015) Decompressive craniectomy after severe traumatic brain injury in children: complications and outcome. Neuropediatrics 46:5–12CrossRefPubMed Pechmann A, Anastasopoulos C, Korinthenberg R, Van Velthoven-Wurster V, Kirschner J (2015) Decompressive craniectomy after severe traumatic brain injury in children: complications and outcome. Neuropediatrics 46:5–12CrossRefPubMed
16.
Zurück zum Zitat De Bonis P, Frassanito P, Mangiola A, Nucci CG, Anile C, Pompucci A (2012) Cranial repair: how complicated is filling a “hole”? Journal of Neurotrama 29:1071–1076CrossRef De Bonis P, Frassanito P, Mangiola A, Nucci CG, Anile C, Pompucci A (2012) Cranial repair: how complicated is filling a “hole”? Journal of Neurotrama 29:1071–1076CrossRef
17.
Zurück zum Zitat Rocque BG, Amancherla K, Lew SM, Lam S (2013) Outcomes of cranioplasy following decompressive craniectomy in the pediatric population. J Neurosurg Pediatrics 12:120–125CrossRef Rocque BG, Amancherla K, Lew SM, Lam S (2013) Outcomes of cranioplasy following decompressive craniectomy in the pediatric population. J Neurosurg Pediatrics 12:120–125CrossRef
18.
Zurück zum Zitat Perlyn CA, Schmelzer R, Govier D, Marsh JL (2005) Congenital scalp and calvarian deficiencies: principles for classification and surgical management. Plast Reconstr Surg 115:1129CrossRefPubMed Perlyn CA, Schmelzer R, Govier D, Marsh JL (2005) Congenital scalp and calvarian deficiencies: principles for classification and surgical management. Plast Reconstr Surg 115:1129CrossRefPubMed
19.
Zurück zum Zitat D’Urso PS, Earwaker WJ, Barker TM, Redmond MJ, Thompson RG, Effeney DJ, Tomlinson FH (2000) Custom cranioplasty using sterolithography and acrylic. Brit J Plast Surg 53: 200–204. D’Urso PS, Earwaker WJ, Barker TM, Redmond MJ, Thompson RG, Effeney DJ, Tomlinson FH (2000) Custom cranioplasty using sterolithography and acrylic. Brit J Plast Surg 53: 200–204.
20.
Zurück zum Zitat Lee SC, CT W, Lee ST, Chen PJ (2009) Cranioplasty using polymethyl methacrylate prostheses. J Clin. Neuroscience 16:56–63 Lee SC, CT W, Lee ST, Chen PJ (2009) Cranioplasty using polymethyl methacrylate prostheses. J Clin. Neuroscience 16:56–63
21.
Zurück zum Zitat Eppley BL (2005) Biochemical testing of alloplastic PMMA cranioplasty materials. J Craniofac Surg 16:140–143CrossRefPubMed Eppley BL (2005) Biochemical testing of alloplastic PMMA cranioplasty materials. J Craniofac Surg 16:140–143CrossRefPubMed
22.
Zurück zum Zitat Di Rienzo A, Iacoangeli M, Di Somma LGM, Alvaro L, Nocchi N, Scerrati M (2012) Shape modifications of porous hydroxyapatite prosthesis to improve rigid implant fixation : experience in 12 cases. Surg Neurol Int 3:161CrossRef Di Rienzo A, Iacoangeli M, Di Somma LGM, Alvaro L, Nocchi N, Scerrati M (2012) Shape modifications of porous hydroxyapatite prosthesis to improve rigid implant fixation : experience in 12 cases. Surg Neurol Int 3:161CrossRef
23.
Zurück zum Zitat Agner C, Dujovny M, Park H (2003) Delayed minimally invasive cranioplasty. Minim Invas Neurosurg 46:186–190CrossRef Agner C, Dujovny M, Park H (2003) Delayed minimally invasive cranioplasty. Minim Invas Neurosurg 46:186–190CrossRef
24.
Zurück zum Zitat Zins JE, Papay FA (2007) Use of calcium-based bone cements in the repair of large, full-thickness cranial defects: a caution. Plast Reconstr Surg 120:1332–1342CrossRefPubMed Zins JE, Papay FA (2007) Use of calcium-based bone cements in the repair of large, full-thickness cranial defects: a caution. Plast Reconstr Surg 120:1332–1342CrossRefPubMed
25.
Zurück zum Zitat Chen TM, Wang HJ (2002) Cranioplasty using allogenic perforated demineralized bone matrix with autogenous bone paste. Ann Pediatr Surg 49(3) Chen TM, Wang HJ (2002) Cranioplasty using allogenic perforated demineralized bone matrix with autogenous bone paste. Ann Pediatr Surg 49(3)
26.
Zurück zum Zitat Frassanito P, De Bonis P, Mattogno PP, Mangiola A, Novello M, Brinchi D, Pompucci A, Anile C (2013) The fate of a macroporous hydroxyapatite cranioplasty 4 years after implantation: Macroscopical and microscopical findings in a case of recurrent atypical meningioma. Clin Neurol Neurosurg 115:1496–1498CrossRefPubMed Frassanito P, De Bonis P, Mattogno PP, Mangiola A, Novello M, Brinchi D, Pompucci A, Anile C (2013) The fate of a macroporous hydroxyapatite cranioplasty 4 years after implantation: Macroscopical and microscopical findings in a case of recurrent atypical meningioma. Clin Neurol Neurosurg 115:1496–1498CrossRefPubMed
27.
Zurück zum Zitat Bibb R, Eggbeer D, Paterson A (2015) Medical modelling: the application of advanced design and rapid prototyping techniques in medicine, 2nd. edn. Elsevier Ltd, p 8–9 Bibb R, Eggbeer D, Paterson A (2015) Medical modelling: the application of advanced design and rapid prototyping techniques in medicine, 2nd. edn. Elsevier Ltd, p 8–9
28.
Zurück zum Zitat Wehrli LA, Zweifel N, Weil R, Altermatt S (2012) Juvenile psammomatoid ossifying fibroma of the forehead, radical resection, and defect coverage with a hydroxyl-apatite composite—a case report. Eur J Pediatr Surg 22(6):479–484CrossRefPubMed Wehrli LA, Zweifel N, Weil R, Altermatt S (2012) Juvenile psammomatoid ossifying fibroma of the forehead, radical resection, and defect coverage with a hydroxyl-apatite composite—a case report. Eur J Pediatr Surg 22(6):479–484CrossRefPubMed
Metadaten
Titel
Hydroxyapatite ceramic implants for cranioplasty in children: a single-center experience
verfasst von
Laura Zaccaria
Sasha Job Tharakan
Stefan Altermatt
Publikationsdatum
24.12.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Child's Nervous System / Ausgabe 2/2017
Print ISSN: 0256-7040
Elektronische ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-016-3327-4

Weitere Artikel der Ausgabe 2/2017

Child's Nervous System 2/2017 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.