Abstract
In a 52 week ovine calvaria implantation model, the restoration of cranial defects with a bare titanium mesh (Ti-mesh) and a titanium mesh embedded in a calcium phosphate (CaP-Ti) were evaluated in seven animals. During the study, no major clinical abnormalities were observed, and all sheep presented a normal neurologic assessment. Blood and cerebrospinal fluid analysis, made at termination, did not show any abnormalities. No indentation of the soft tissue was observed for either test article; however, the Ti-mesh burr-hole covers were associated with filling of the calvarial defect by fibrous tissue mainly. Some bone formation was observed at the bottom of the created defect, but no significant bone was formed in the proximity of the implant. The defect sites implanted with CaP-Ti were characterized by a moderate degradation of the calcium phosphate (CaP) that was replaced by mature bone tissue. Calcium-phosphate-filled macrophages were observed in all animals, indicating that they might play a vital role in osteogenesis. The newly formed bone was present, especially at the bony edges of the defect and on the dura side. Integration of the Ti-mesh in a CaP improved bone formation and osteointegration in comparison to a bare Ti-mesh.
Highlights
The restoration of cranial defects after craniectomies or craniotomies is a common neurosurgical procedure with defects ranging from small burr-holes up to large cranial defects
This study aims to compare the biological performance as well as tissue and systemic effects in a 52 weeks ovine calvarial implantation model of a bare titanium mesh (Ti-mesh) against a titanium mesh embedded in a calcium phosphate (CaP-Ti)
We found that the CaP-Ti reinforced burr-hole cover significantly improved bone formation and tissue response after 52 weeks of implantation, whilst the Ti-mesh exhibited a thick fibrous tissue with minimal to absent osteointegration or osteoconduction
Summary
The restoration of cranial defects after craniectomies or craniotomies is a common neurosurgical procedure with defects ranging from small burr-holes up to large cranial defects. The major drawbacks of several alloplastic materials are the slow or lack of osteointegration with the patient’s bone and soft tissue related complications, whilst autologous bone flaps generally elicit high rates of resorption over time or cause donor site morbidity [1,2,3,4]. One alternative is calcium phosphate (CaP) ceramics that have shown high potential due to their biocompatibility [11], osteoconductivity [12] and ability to develop a direct, adherent and strong bonding with the bone [13]. They are degradable and can be replaced by bone during the healing process. A low clinical complication rate has been observed [22] with an indication that the material is replaced with bone during the healing process for the given CaP mixture [22, 24, 25]
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