A Novel Titanium Cranioplasty Technique of Marking the Coronal and Squamosoparietal Sutures in Three-Dimensional Titanium Mesh as Anatomical Positioning Markers to Increase the Surgical Accuracy and Reduce Postoperative Complications.

Bing-Sen Xie,De-Zhi Kang,Shu-Fa Zheng,Fang-Yu Wang,Wen-Hua Fang,Yuan-Xiang Lin

doi:10.3389/fsurg.2021.754466

Abstract

Objective: The objective of this research is to modify the titanium cranioplasty (Ti-CP) technique to increase the surgical accuracy and preliminarily verify the effectiveness and safety of this improvement.Methods: We developed a novel technique of marking the coronal and squamosoparietal sutures in three-dimensional (3D) titanium mesh as anatomical positioning markers and designed a prospective trial in patients with a unilateral frontotemporoparietal skull defect. Patients were randomly divided into two groups by the presence or absence of the anatomical positioning markers, and the therapeutic effects of these two groups were compared.Results: Forty-four patients were included in this study, including 28 (64%) males and 16 (36%) females. The mean age was 44.8 ± 15.2 years (range, 13–75 years). Overall postoperative complication rate of the intervention group (18%) was significantly (P = 0.03) lower than the control group (50%). Surgical accuracy of the intervention group (97.8%) was significantly (P < 0.001) higher than the control group (94%). Visual analog scale for cosmesis (VASC) of the intervention group (8.4) was significantly (P < 0.001) higher than the control group (7). The overall postoperative complication rate was 34%. Multivariate analyses showed that surgical accuracy <95.8% (OR = 19.20, 95% CI = 3.17–116.45, P = 0.001) was significantly associated with overall postoperative complications. Independent predictor of overall postoperative complications was surgical accuracy (OR = 0.57, 95% CI = 0.40–0.82, P = 0.002).Conclusions: This novel technique for repairing frontotemporoparietal skull defects increases surgical accuracy, improves cosmetic prognosis, and reduces postoperative complications. Therefore, it is a safe and effective improvement for Ti-CP.

Highlights

Cranioplasty (CP) is a well-known and frequent procedure in modern neurosurgery
The surgical accuracy of Titanium cranioplasty (Ti-CP) refers to the accuracy of the placement of titanium mesh
Coronal and squamosoparietal sutures are observed in the skull. (B) CP using 3D titanium mesh

Summary

Introduction

Cranioplasty (CP) is a well-known and frequent procedure in modern neurosurgery. Brain protection and cosmetic aspects are the major indications [1]. Many different products ranging from autologous bone grafts to synthetic materials are used for CP [2]. Autologous CP using the previously removed bone flap from the decompressive craniectomy (DC) is the first-line treatment for covering the large skull defect [3]. Both bacterial infections and absorption of the bone are common problems [4]. The use of prosthetic material is a standard practice in most hospitals in China [5]. Titanium has become one of the most widely used prosthetic materials due to its chemical and biological stability [6]. It can be made symmetrical to the contralateral side of the skull and fit perfectly to skull bones of patients by using the three-dimensional (3D) titanium mesh [6]

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Discussion

Conclusion