Skull Defects Research Articles

Characteristics and Clinical Significance of Skull Defect Restoration in Young Patients: A Single-center Report and Literature Review.

The objective of this study is to observe cranial regeneration following cranial defects in young patients and analyze the factors influencing the regeneration process. In this retrospective study, a comparative and analytical assessment was conducted on the clinical data of 2 distinct cohorts: the observation group comprised patients aged ≤22 years with a regenerated cranial area ≥4cm2 following cranial defects, while the control group consisted of individuals with cranial defects persisting for over 1 year and a regenerated cranial area measuring <4cm2. These patients had been admitted to our department from August 2008 to October 2022. In addition, an analysis was undertaken to discern the pertinent factors influencing the process of cranial regeneration. Among the 32 patients in the observation group, 9 patients developed complications after decompressive craniectomy (DC) (hereafter referred to as post-DC complications); all the patients in this group, except one, underwent cranioplasty. The control group consisted of 12 patients, all of whom had post-DC complications and underwent cranioplasty; among them, 4 patients with a coexisting complication of hydrocephalus also underwent ventriculoperitoneal shunting. Cranial regeneration was observed in all 23 patients who did not have post-DC complications and in 9 of the 21 patients with post-DC complications. The rate of cranial regeneration was lower in the group with post-DC complications than in the group without post-DC complications, and the observation time (the time from cranial defect to the completion of cranioplasty) was longer in patients in the group with post-DC complications than those in the group without post-DC complications. Cranial bone regeneration can be achieved in young patients with cranial defects if factors favorable to cranial regeneration are effectively managed. These include preserving the dura mater, periosteum, and diploe during the surgery and maintaining good physical conditions postoperatively. The distribution pattern of the regenerated bones aligns with the shape of the flap. Post-DC complications represent adverse factors that can negatively affect cranial regeneration.

3D-Printed Bifunctional Scaffold for Treatment of Critical Bone Defects Based on Osteoimmune Microenvironment Regulation and Osteogenetic Effects.

The critical-sized bone defect resulting from trauma, tumor resection, and congenital deformity fails to undergo spontaneous healing due to its substantial size, while the ensuing inflammatory process and hypoxic environment further impede the regenerative process. Therefore, it has consistently presented a significant clinical challenge. In the present study, we incorporate a glycyrrhizic acid (GA)-functionalized hydrogel onto the surface of a Hydroxyapatite (Hap)-modified Polycaprolactone (PCL) scaffold to fabricate a composite scaffold. The composed scaffold showed favorable anti-inflammatory and antioxidative capabilities by modulating macrophage polarization and scavenging reactive oxygen species (ROS); the modification of Hap enhanced its osteogenic ability. An in vivo rat skull defect model confirmed that the composed scaffold efficiently promotes bone regeneration. In general, the composed scaffold with the ability of osteoimmune microenvironment regulation can effectively repair critical-sized bone defects. This strategy provides a promising method for the reconstruction of large segmental bone defects.

Fabrication of composite RGD-tagged poly(lactic acid)-graphene oxide nanofiber containing bone-forming peptide-3 loaded-dendritic silica nanoparticles for bone regeneration in rabbit

In the current study, polylactic acid (PLA)/graphene oxide (GO) based composite scaffolds were fabricated by electrospinning method and then covalently modified with bone-forming peptide-3 (BFP-3)-loaded thiol-functionalized dendritic mesoporous silica nanoparticles (BFP-3@HS-DMSNs) and RGD. In this regard, PLA electrospinning nanofibers and composite of PLA/GO electrospinning nanofibers containing 0.02, 0.01, 0.04, 0.1, 0.2 % of GO were prepared and characterized in terms of mechanical strength, nanofibers diameter, thermal stability, crystallinity, specific surface area, total pore volume and cell adhesion properties. Among the prepared composites, PLA nanofibers containing 0.02 % GO demonstrated superior mechanical and morphological characteristics along with better cell adhesion for mesenchymal stem cell. Then, the PLA/0.02 %GO nanofiber was treated with plasma and consequently modified with N-(2-aminoethyl)maleimide linker which was applied for Cys-RGD and BFP-3@HS-DMSNs conjugation. The obtained results showed desirable adhesion of PLA/0.02 %GO nanofiber after incorporation of RGD (5 % of maleimide groups of the linker) and DMSNs which significantly increase cell adhesion potency (1.53 folds). By incorporation of BFP-3@HS-DMSNs (equivalent to 0.1 µg of BFP-3) to the RGD-tagged PLA/0.02 %GO nanofiber, the scaffold demonstrated better cytocompatibility and MSC differentiation to osteoblast based on biomineralization assay via alizarin red (4.2 folds) and alkaline phosphatase activity (1.7 folds) tests. In preclinical stage, after skull defect creation in rabbits, 5 treatments groups comprising PLA/0.02 %GO nanofiber, PLA/0.02 %GO/DMSNs, PLA/0.02 %GO/DMSNs/Cys-RGD, PLA/0.02 %GO/BFP-3@DMSNs and PLA/0.02%GO/BFP-3@DMSNs/Cys-RGD were used for bone regeneration in skull defects. After 3 months, the implantation of PLA/0.02GO/BFP-3@DMSNs/Cys-RGD showed higher bone regeneration based on CBCT imaging (18.875 mm2 bone formed area) in comparison with other treatment groups. This hybrid multimodal platform is purposely organized interactive processes which lead to potential bone regeneration.

Highly porous sildenafil loaded polylactic acid/polyvinylpyrrolidone based 3D printed scaffold containing forsterite nanoparticles for craniofacial reconstruction

Tissue engineering has emerged as a promising substitute for traditional tissue repair methods. Nowadays, advancements in 3D printing technology have enabled the fabrication of customized scaffolds to support tissue regeneration. In the present study, a polylactic acid-polyvinylpyrrolidone 3D-printed scaffold containing 10 % forsterite was fabricated. Subsequently, lyophilized fucoidan microstructures loaded with sildenafil were filled the channels of this 3D-printed scaffold. The fabricated scaffold loaded with sildenafil was thoroughly characterized, revealing that 97.46 % of the loaded sildenafil was released in a sustained manner over 28 days. Furthermore, the biocompatibility of MG63 was evaluated through cell viability and adhesion tests. The findings indicated a direct and favorable influence on cell behavior. Based on the chicken chorioallantoic membrane assay, the fabricated scaffold significantly increases angiogenesis due to the sustained release of sildenafil. Moreover, in-vivo studies conducted on a rat model demonstrated that the 3D-printed scaffold was able to stimulate and accelerate the repair of calvarial defects within 8 weeks, and the amount of new bone tissue formation was significantly higher than that of other experimental groups. Based on the comprehensive in-vitro and in-vivo assessments, the scaffold with a macro- and microporous structure combined with the ability to release sildenafil is suggested as a potential candidate for repairing bone tissue, especially in the context of skull defects.

Preoperative Planning of Craniectomy and Reconstruction using 3D Printed Cranioplasty for Treatment of Calvarial Lesion

There is a number of diseases which causes calvarial lesion. Fibrous dysplasia, intraosseous meningioma, osteoma is to name a few. Treatment of these lesions necessitates removal of part of the skull or craniectomy to decompress the brain and neural elements. The ensuing skull defect needs to be repaired to protect the brain. Previously used allograft and alloplastic materials have been replaced with newer PEEK material, which is more resistant, biocompatible and can be 3D printed. In this series we describe 4 cases in which skull lesions are removed and reconstructed in the same sitting using 3D printed PEEK implant designed preoperatively using high resolution CT data. The results are superior and complication rates are low. All the cases were done in different government hospitals. The technical process was developed indigenously, and the methods are the first in our country. Bang. J Neurosurgery 2024; 13(2): 64-69

Hierarchical Integration of Curcumin-Loaded CaCO3 Nanoparticles and Black Phosphorus Nanosheets in Core/Shell Nanofiber for Cranial Defect Repair.

Reconstruction and healing of large craniofacial bone defects are major clinical challenges due to high risk of chronic inflammation and reduced cell mineralization levels. Herein, a core-shell nanofiber-based implant with significant pro-osteogenesis capability for treating skull defects is reported, which is hierarchically integrated with curcumin-loaded calcium carbonate nanoparticles (CaCO3@Cur NPs) in the outer layers and black phosphorus nanosheets (BPNSs) in the core compartments. The radical alignment of the integrated nanocomponents allows the sequential in situ release of the therapeutic agents in a controlled manner after implantation. Curcumin can repolarize M1 macrophages into M2 phenotypes for anti-inflammation purposes. Meanwhile, the released calcium and phosphate ions can promote the biomineralization of hydroxyapatite at the defect site and facilitate bone regeneration. Evaluations on cranial defect-bearing rat models demonstrated that the electrospun fibers in the present study substantially promoted restoration of the damaged skulls and inhibited inflammation in the wound bed. This strategy provides a new idea for the treatment of skull defects in the clinic.

Reconstruction of Extensive Scalp and Skull Defects with Dural Exposure: Report of a Series of Cases and Literature Review.

Large scalp and calvarial defects pose significant challenges for reconstruction. Successful reconstruction necessitates soft tissue restoration capable of withstanding radiation following tumor resection. Free flaps allow preserving and maintaining the structural and functional status of the reconstructed area. This article presents our experience with microsurgical free tissue transfer for scalp and calvarial defects as well as a literature review on the subject. A retrospective study was conducted to retrieve the files of all the extensive scalp/forehead defects with dural exposure treated in the plastic surgery department of Hotel Dieu de France University Hospital from September 2006 to December 2023. Twelve free tissue transfers were performed in 11 patients between 2006 and 2023. In 3 cases, a 2-stage procedure was performed with the transfer of the free flap in the first stage and the ablative surgery in the second stage 1 week later. A muscular latissimus dorsi flap was used in 9 cases. In 3 patients, the defect involved the forehead and required cutaneous flaps: 2 radial forearm flaps and 1 parascapular flap. Complications included 1 flap venous thrombosis, 2 hematomas, 1 subdural hematoma, and 2 cases of distal flap necrosis. Free tissue transfer is indispensable for addressing large defects of the scalp and calvaria. A 2-stage operation is warranted for debilitated patients with a high risk of complications. The latissimus dorsi muscle flap is the flap of choice to cover extensive defects. Delayed cranioplasty is preferable in contaminated wounds.

A multifunctional self-reinforced injectable hydrogel for enhancing repair of infected bone defects by simultaneously targeting macrophages, bacteria, and bone marrow stromal cells

Injectable hydrogels (IHs) have demonstrated huge potential in promoting repair of infected bone defects (IBDs), but how to endow them with desired anti-bacterial, immunoregulatory, and osteo-inductive properties as well as avoid mechanical failure during their manipulation are challenging. In this regard, we developed a multifunctional AOHA-RA/Lap nanocomposite IH for IBDs repair, which was constructed mainly through two kinds of reversible cross-links: (i) the laponite (Lap) crystals mediated electrostatic interactions; (ii) the phenylboronic acid easter bonds between the 4-aminobenzeneboronic acid grafted oxidized hyaluronic acid (AOHA) and rosmarinic acid (RA). Due to the specific structural composition, the AOHA-RA/Lap IH demonstrated superior injectability, self-recoverability, spatial adaptation, and self-reinforced mechanical properties after being injected to the bone defect site. In addition, the RA molecules could be locally released from the hydrogel following a Weibull model for over 10 days. Systematic in vitro/vivo assays proved the strong anti-bacterial activity of the hydrogel against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). Moreover, its capability of inducing M2 polarization of macrophages (Mφ) and osteogenic differentiation of bone marrow stromal cells (BMSCs) was verified either, and the mechanism of the former was identified to be related to the JAK1-STAT1 and PI3K-AKT signaling pathways and that of the latter was identified to be related to the calcium signaling pathway, extracellular matrix (ECM) receptor interaction and TGF-β signaling pathway. After being implanted to a S. aureus infected rat skull defect model, the AOHA-RA/Lap IH significantly accelerated repair of IBDs without causing significant systemic toxicity. Statement of significanceRosmarinic acid and laponite were utilized to develop an injectable hydrogel, promising for accelerating repair of infected bone defects in clinic. The gelation of the hydrogel was completely driven by two kinds of reversible cross-links, which endow the hydrogel superior spatial adaption, self-recoverability, and structural stability. The as-prepared hydrogel demonstrated superior anti-bacterial/anti-biofilm activity and could induce M2 polarization of macrophages and osteogenic differentiation of BMSCs. The mechanism behind macrophages polarization was identified to be related to the JAK1-STAT1 and PI3K-AKT signaling pathways. The mechanism behind osteogenic differentiation of BMSCs was identified to be related to the ECM receptor interaction and calcium signaling/TGF-β signaling pathways.

Safety of labor, Valsalva maneuver, and neuraxial anesthesia for pregnant women after decompressive craniectomy: Case series and review of the literature.

Decompressive craniectomies are a neurosurgical operation aimed at normalizing intracranial pressure (ICP). Occasionally, there is delayed replacement of the skull resulting in an acquired skull defect. When managing laboring patients with an acquired skull defect there is often fear associated with traditional labor involving the Valsalva maneuver and with neuraxial anesthesia. These fears typically stem from potential ICP changes and risk of herniation. In reviewing the literature, only 15 cases are described detailing labor management after decompressive craniectomy (DC), mostly with incomplete labor histories. We aim to expand that literature by reporting two cases of safe labor with epidural anesthesia in patients with large skull defects. The first described patient underwent a cranioplasty during pregnancy because of trauma. Later, because of concerns for pre-eclampsia, induction of labor was initiated and she received neuraxial anesthesia via epidural. The patient ultimately underwent cesarean delivery 48 h after induction began due to nonreassuring fetal heart tones. The second patient underwent a cranioplasty because of infection prior to pregnancy. Once in labor, she was cleared by neurosurgery and the anesthesia team placed her epidural. She later underwent an uncomplicated standard vaginal delivery. The existing literature on labor following DC is sparse. Retrospective review of case reports can advance discussion and standardization regarding care for laboring women with a history of DC. We advocate that the Valsalva maneuver and epidural anesthesia is safe for pregnant women who are neurologically asymptomatic.

Ultrasound-triggered piezoelectric polyetheretherketone with boosted osteogenesis via regulating Akt/GSK3β/β-catenin pathway

Maxillofacial bone defects can severely impact quality of life by impairing physiological functions such as chewing, breathing, swallowing, and pronunciation. Polyether ether ketone (PEEK) is commonly used for the repair of maxillofacial defects due to its mechanical adaptability, while its osteogenic properties still need refinement. Herein, we have utilized the piezoelectric effect exhibited by barium titanate (BTO) under low-intensity pulsed ultrasound (LIPUS) to develop an ultrasound responsive PEEK (PDA@BTO-SPEEK, PBSP) through the mediating effect of polydopamine (PDA), for repairing maxillofacial bone defects. After modification by PDA@BTO, PBSP possesses better hydrophilicity, which is conducive to cell growth and adhesion. Simultaneously, by virtue of the piezoelectric characteristics of BTO, PBSP obtains a piezoelectric coefficient that matches the bone cortex. Notably, when PBSP is stimulated by LIPUS, it can generate stable electricity and effectively accelerate the osteogenic differentiation of osteoblasts through the regulation of the Piezo1-induced calcium (Ca2+) influx and Akt/GSK3β/β-catenin pathway. In addition, PBSP presents satisfactory therapeutic effects in rat skull defect models, and its osteogenic efficiency can be further improved under LIPUS stimulation with high tissue penetration. Collectively, PBSP + LIPUS exhibits great potential as a promising alternative strategy for the repair of maxillofacial bone defects.

Copper ions-photo dual-crosslinked alginate hydrogel for angiogenesis and osteogenesis.

Early healing of bone defects is still a clinical challenge. Many bone-filling materials have been studied, among which photocrosslinked alginate has received significant attention due to its good biocompatibility and morphological plasticity. Although it has been confirmed that photocrosslinked alginate can be used as an extracellular matrix for 3D cell culture, it lacks osteogenesis-related biological functions. This study constructed a copper ions-photo dual-crosslinked alginate hydrogel scaffold by controlling the copper ion concentration. The scaffolds were shaped by photocrosslinking and then endowed with biological functions by copper ions crosslinking. According to in vitro research, the dual-crosslinked hydrogel increased the compressive strength and favored copper dose-dependent osteoblast differentiation and cell surface adherence of rat bone marrow mesenchymal stem cells and the expression of type I collagen (Col1), runt-related transcription factor 2 (Runx2), osteocalcin (OCN), vascular endothelial growth factor (VEGF). In addition, hydrogel scaffolds were implanted into rat skull defects, and more angiogenesis and osteogenesis could be observed in in vivo studies. The above results show that the copper-photo-crosslinked hydrogel scaffold has excellent osseointegration properties and can potentially promote angiogenesis and early healing of bone defects, providing a reference solution for bone tissue engineering materials.

Individualized surgical management of acute intracranial infection-associated hydrocephalus

Objective: This study aims to discuss and summarize surgical treatments for acute intracranial infections with hydrocephalus as a supplement to antibiotic treatment. Methods: A total of 29 patients diagnosed with acute intracranial infection associated with hydrocephalus were divided into three groups for comparison and analysis of surgical interventions and outcomes. Results: In this study, 29 patients in one group underwent surgical treatment, while 28 received various forms of external cerebrospinal fluid (CSF) drainage, with a maximum of 5 drainage procedures. Additionally, 6 patients had Ommaya reservoir implantation, 6 had debridement, and 11 had a hydrocephalus shunt. Among the five patients in Group 1, all underwent shunt device extubation. The statistical analysis revealed no significant difference in surgical modes between the groups, but the outcomes did show a statistically significant difference (χ2 = 6.433, P = 0.040). Conclusion: Individualized and multiple surgeries are needed for acute intracranial infection associated with hydrocephalus. In cases where the infection is secondary to a shunt, the primary surgical approach involves removing the shunt device. In situations where the infection is linked to hydrocephalus following different craniotomies, addressing scalp infection, cerebrospinal fluid leakage, and skull defects is essential. In instances of community-acquired intracranial infection associated with hydrocephalus, continuing drainage of cerebrospinal fluid is imperative.

RADSC-loaded tubular units composed of multilayer electrospun membranes promoted bone regeneration of critical-sized skull defects

rADSC-loaded tubular units composed of multilayer electrospun membranes promoted bone regeneration of critical-sized skull defects

Assessment of cranial reconstruction utilizing various implant materials: finite element study

The human head can sometimes experience impact loads that result in skull fractures or other injuries, leading to the need for a craniectomy. Cranioplasty is a procedure that involves replacing the removed portion with either autologous bone or alloplastic material. While titanium has traditionally been the preferred material for cranial implants due to its excellent properties and biocompatibility, its limitations have prompted the search for alternative materials. This research aimed to explore alternative materials to titanium for cranial implants in order to address the limitations of titanium implants and improve the performance of the cranioplasty process. A 3D model of a defective skull was reconstructed with a cranial implant, and the implant was simulated using various stiff and soft materials (such as alumina, zirconia, hydroxyapatite, zirconia-reinforced PMMA, and PMMA) as alternatives to titanium under 2000N impact forces. Alumina and zirconia implants were found to reduce stresses and strains on the skull and brain compared to titanium implants. However, PMMA implants showed potential for causing skull damage under current loading conditions. Additionally, PMMA and hydroxyapatite implants were prone to fracture. Despite these findings, none of the implants exceeded the limits for tensile and compressive stresses and strains on the brain. Zirconia-reinforced PMMA implants were also shown to reduce stresses and strains on the skull and brain compared to PMMA implants. Alumina and zirconia show promise as alternatives to titanium for the production of cranial implants. The use of alternative implant materials to titanium has the potential to enhance the success of cranial reconstruction by overcoming the limitations associated with titanium implants.Graphical

Daily life without cranial bone protection while awaiting cranioplasty: a qualitative study

PurposeDecompressive craniectomy is occasionally performed as a life-saving neurosurgical intervention in patients with acute severe brain injury to reduce refractory intracranial hypertension. Subsequently, cranioplasty (CP) is performed to repair the skull defect. In the meantime, patients are living without cranial bone protection, and little is known about their daily life. This study accordingly explored daily life among patients living without cranial bone protection after decompressive craniectomy while awaiting CP.MethodsA multiple-case study examined six purposively sampled patients, patients’ family members, and healthcare staff. The participants were interviewed and the data were analyzed using qualitative content analysis.ResultsThe cross-case analysis identified five categories: “Adapting to new ways of living,” “Constant awareness of the absence of cranial bone protection,” “Managing daily life requires available staff with adequate qualifications,” “Impact of daily life depends on the degree of recovery,” and “Daily life stuck in limbo while awaiting cranioplasty.” The patients living without cranial bone protection coped with daily life by developing new habits and routines, but the absence of cranial bone protection also entailed inconveniences and limitations, particularly among the patients with greater independence in their everyday living. Time spent awaiting CP was experienced as being in limbo, and uncertainty regarding planning was perceived as frustrating.ConclusionThe results indicate a vulnerable group of patients with brain damage and communication impairments struggling to find new routines during a waiting period experienced as being in limbo. Making this period safe and reducing some problems in daily life for those living without cranial bone protection calls for a person-centered approach to care involving providing contact information for the correct healthcare institution and individually planned scheduling for CP.

Ethmoid Sinus Mucocele Penetrating the Anterior Skull Base: A Case Report

Sinus mucoceles are nonmalignant cystic tumors lined by non-neoplastic epithelium, typically involving the frontal and ethmoid sinuses. Although it is common for these mucoceles to cause destruction of surrounding bone tissue due to their growth, cerebrospinal fluid leaks resulting from skull base penetration by an ethmoid sinus mucocele have rarely been reported. A 24-year-old male patient presented with right proptosis and right periorbital pain, who underwent bilateral endoscopic sinus surgery 12 years ago. Endoscopic sinus surgery was performed to treat the right ethmoid sinus mucocele, and confirmed the presence of a basal skull defect during surgery. We reconstructed the skull base defect using septal cartialge and free mucosal graft. The symptoms were completely resolved after surgery and no cerebrospinal fluid leakage was noted during follow up period. This case report highlights a rare instance of direct mucocele extension to the skull base.

Organic-inorganic nHA-Gelatin/Alginate high strength macroporous cryogel promotes bone regeneration

Macroporous cryogel has the advantages of nutrient exchange and cell growth, and is an ideal material for tissue regeneration. In order to strengthen the machenical properties of cryogel for the widely use, a high strength gelatin/sodium alginate/nano hydroxyapatite (nHA) porous cryogel (GA-HA cryogel) was prepared by a simple freeze-thaw process. The mechanical strength of GA-HA cryogel increased significantly with the increase of nHA content. In vitro studies showed that GA-HA cryogel had good biocompatibility and no obvious cytotoxicity to MC3T3-E1 cells. The results of alkaline phosphatase activity assay and osteocalcin immunofluorescence staining showed that GA-HA1 porous hydrogel system could significantly increase the expression of MC3T3-E1 alkaline phosphatase and osteocalcin when the content of nHA was 1 ​%. In addition, porous GA-HA cryogel showed good performance in promoting bone regeneration in rat skull defect model. Therefore, the high-strength double network cryogel prepared in this study can provide new applications in bone repair and tissue regeneration.

Preoperative planning of craniectomy and reconstruction using three-dimension-printed cranioplasty for treatment of calvarial lesion.

Common calvarial lesions include fibrous dysplasia (FD), intraosseous meningioma, osteoma, Langerhans cell histiocytosis (LCH), intraosseous hemangioma, dermoid and epidermoid cyst, and malignancy. Surgical removal with removal of the involved skull is the choice of treatment for these lesions. Previously, the skull defect was repaired using allograft, and alloplastic materials have been replaced with newer polyetheretherketone (PEEK) material, which is more resistant, biocompatible, and can be 3-dimension (3D)--printed. High-resolution 3D printing uses very fine extruders to put materials in fine layers to recreate patients' anatomy authentically, which gives superior cosmetic outcomes. Our objectives were preoperative planning of craniectomy and reconstruction for calvarial lesions and reconstruction of skull defects using 3D-printed cranioplasty with PEEK materials. In this series, we describe 11 cases in which skull lesions were removed and reconstructed in the same sitting using a 3D-printed PEEK implant designed preoperatively using high-resolution computer tomography. All the cases were done in the neurosurgery department of Bangabandhu Sheikh Mujib Medical University from 2021 to 2023. Patients were followed up for 6 months after surgery. Regarding 11 cases, six cases were FD, three cases were intraosseous meningioma, one case was intraosseous hemangioma, and one case was LCH. Average lesion size were 12.73-5.77 cm. Cranioplasty was done with PEEK material. Minor complications were treated conservatively. Seroma, postoperative fever, and nausea were among these. The human bone-like biocompatibility and resistance to physical forces leads to more frequent use of PEEK, which enables to repair of complex craniofacial defects with better cosmesis. Despite some limitations, the PEEK cranioplasty implant continued to thrive and showed its promise to be an excellent material. Further, research and investment should be put into developing the technique.

Humidity-Responsive Amorphous Calcium-Magnesium Pyrophosphate/Cassava Starch Scaffold for Enhanced Neurovascular Bone Regeneration.

Developing a neurovascular bone repair scaffold with an appropriate mechanical strength remains a challenge. Calcium phosphate (CaP) is similar to human bone, but its scaffolds are inherently brittle and inactive, which require recombination with active ions and polymers for bioactivity and suitable strength. This work discussed the synthesis of amorphous magnesium-calcium pyrophosphate (AMCP) and the subsequent development of a humidity-responsive AMCP/cassava starch (CS) scaffold. The scaffold demonstrated enhanced mechanical properties by strengthening the intermolecular hydrogen bonds and ionic bonds between AMCP and CS during the gelatinization and freeze-thawing processes. The release of active ions was rapid initially and stabilized into a long-term stable release after 3 days, which is well-matched with new bone growth. The release of pyrophosphate ions endowed the scaffold with antibacterial properties. At the cellular level, the released active ions simultaneously promoted the proliferation and mineralization of osteoblasts, the proliferation and migration of endothelial cells, and the proliferation of Schwann cells. At the animal level, the scaffold was demonstrated to promote vascular growth and peripheral nerve regeneration in a rat skull defect experiment, ultimately resulting in the significant and rapid repair of bone defects. The construction of the AMCP/CS scaffold offers practical suggestions and references for neurovascular bone repair.

Autograft cranioplasty for the correction of a severe frontal skull defect due to hypocalvaria: A case report and review in management

Objective. Here, the authors describe their institutional experience in managing a patient with severe frontal skull defect due to hypocalvaria with brain herniation. Material and methods. The study was conducted in the Neurosurgery Department, “Dr. Soetomo” Academic General Hospital, Surabaya, Indonesia. The neonates had a congenital anomaly, with skull defect in frontal skull duo to hypocalvaria. Defect closure with autograft cranioplasty using skull bone was performed in surgery. Outcome. The surgery was performed with autograft cranioplasty using the temporal bone on the left region. We performed decompression of the left temporal area and insertion of a ventriculo-peritoneal shunt at the right keen point to reduce intracranial pressure. Surgical treatment of patient with severe skull defect had to be done. Conclusion. Autograft with skull cranioplasty is biocompatible, as it is more easily harvested and with less infection and reaction risks.