Cranioplasty with the Porous Polyethylene Implant(Medpor) for Large Cranial Defect

  • Hong, Ki-Sun (Department of Neurosurgery, College of Medicine, Korea University) ;
  • Kang, Shin-Hyuk (Department of Neurosurgery, College of Medicine, Korea University) ;
  • Lee, Jang-Bo (Department of Neurosurgery, College of Medicine, Korea University) ;
  • Chung, Yong-Gu (Department of Neurosurgery, College of Medicine, Korea University) ;
  • Lee, Hoon-Kap (Department of Neurosurgery, College of Medicine, Korea University) ;
  • Chung, Heung-Seob (Department of Neurosurgery, College of Medicine, Korea University)
  • 발행 : 2005.08.28

초록

Objective : This paper describes our experience and implant technique for cranioplasty of a large cranial defects using a porous polyethylene implant[Medpor] and compares the results with polymethylmethacrylate[PMMA]. Methods : Sixteen cranioplasties were performed using Medpor[n= 10] and PMMA[n=6] implants between June 2003 and January 2005. The criterion for patient enrollment was a defect larger than 10cm in diameter. This study compared the operation times and complications. Results : The operation times ranged from 105 to 250minutes[Mean $180^{\circ}{\pm}44minutes$) in Medpor and from 185 to 460minutes [mean 128minutes] in PMMA. The absolute operation times were shorter using the Medpor implant and the differences were statistically significant[P=0.030]. Satisfactory cosmetic results were obtained in all cases using the Medpor implant and with no implant-related complications. Bone ingrowth to the medpor implant was presumed to be the result on an increase in Houndsfield units of the implant, particularly at the marginal areas in the serial follow-up brain computed tomography images. Conclusion : It is believed that the properties of a Medpor implant make this implant an good alternative to the existing methods of a cranial contour correction. However, a further follow-up study will be needed.

키워드

참고문헌

  1. Blum KS, Schneider SJ, Rosenthal AD : Methyl methacrylate cranioplasty in children : Long-term result, Pediatr Neurosurg 26 : 33-35, 1997 https://doi.org/10.1159/000121158
  2. Couldwell WT, Chen TC, Weiss MH, Takanori F, Willam D : Cranioplasty with the Medpor porous polyethylene Flexblock implant. J Neurosurg : 483-486,1994 https://doi.org/10.3171/jns.1994.81.3.0483
  3. Cushing H : The establishment of cerebral hernia as a decompressive measure for inaccessible brain tumor: with bone defect in temporal and occipital regions. Surg Gynecol Obstet 1 : 297-314, 1905
  4. Dougherty W, WelIisz T :The narural history of alloplastic implants in orbital floor reconstruction: an animal model. J Craniofac Surg 5 : 26-32, 1994 https://doi.org/10.1097/00001665-199402000-00007
  5. Durham SR, McComb JG, Levy ML : Correction of large (> 25cm2) cranial defects with 'reinforced' hydroxyapatite cement: technique and complications. Neurosurgery 52 : 842-845, 2003 https://doi.org/10.1227/01.NEU.0000054220.01290.8E
  6. Eppley BL, Sadove AM : Effects of material porosity on implant bonding strength in a craniofacial model. J Craniofac Surg 1 : 191-202, 1979 https://doi.org/10.1097/00001665-199001040-00008
  7. Gaab MR, Rittierodt M, Lorenz M, Heissler HE : Traumatic brain swelling and operative decompression: a prospective investigation. Acta Neurochir Suppl 51 : 326-328, 1990
  8. Holmes RE : Bone regeneration within a coralline hydroxyapatite implant. Plast Reconstr Surg 63 : 626-633, 1979 https://doi.org/10.1097/00006534-197905000-00004
  9. Klawitter JJ, Bagwell JG, Weinstein AM, Sauer BW : An evaluation of bone growth into porous high density polyethylene. J Biomed Mater Res 10: 311-323, 1976 https://doi.org/10.1002/jbm.820100212
  10. Malis LI : Titanium mesh and acrylic cranioplasty. Neurosurgery 25 : 351-355, 1989 https://doi.org/10.1227/00006123-198909000-00005
  11. Maniker A, Cantrell S, Vaicys C : Failure of hydroxyapatite cement to set in repair of a cranial defect: case report. Neurosurgery 43 : 953-954, 1998 https://doi.org/10.1097/00006123-199810000-00134
  12. Miyaka H, Ohta T, Tanaka H : A new technique for cranioplasty with L-shaped titanium plates and combination ceremic implants composed of hydroxyapatite and tricalcium phosphate(Ceratite). Neurosurgery 46: 414-418, 2000 https://doi.org/10.1097/00006123-200002000-00028
  13. Moreira-Gonzalez A, Jackson IT, Miyawaki T, Barakat K, DiNick V : Clinical outcome in cranioplasty : critical review in long-term follow-up. J Craniofac Surg 14: 144-153, 2003 https://doi.org/10.1097/00001665-200303000-00003
  14. Ousterhout DK, Baker S, Zolotolow I : Methylmethacrylate onlay implants in the treatment of forehead deformities secondary to craniosynostosis. J Maxillofac Surg 8: 228-233, 1980 https://doi.org/10.1016/S0301-0503(80)80105-6
  15. Polin RS, Shaffrey ME, Bogaev CA, Tisdale N, Germanson T, Bocchicchio B, et al : Decompressive bifronral craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41 : 81-94, 1997
  16. Pompili A Caroli F, Carpanese L, Carerio M, Raus L, Sestili G : Cranioplasty performed with a new osteoconductive osteoinducing hydroxyapatite-derived material. J Neurosurg 89 : 236-242, 1998 https://doi.org/10.3171/jns.1998.89.2.0236
  17. Prolo DJ, Oklund SA : The use of bone grafts and alloplasic materials in cranioplasty. Clin Orthop 268 : 270-278, 1991
  18. Ransohoff J, Benjamin MY, Gage EL Jr, Epstein F : F Hemicraniectomy in the management of acute subdural hematoma. J Neurosurg 34 : 70-76, 1971 https://doi.org/10.3171/jns.1971.34.1.0070
  19. Rish BL, Dillon JD, Meirowsky AM, Caveness WF, Mohr JP, Kistler JP, et al : Cranioplasty: a review of 1030 cases of penetrating head injury. Neurosurgery 4 : 381-385,1979 https://doi.org/10.1227/00006123-197905000-00002
  20. Romano JJ, Iliff NT, Manson PN: Use ofMedpor porous polyethylene implants in 140patients with facial fractures. J Craniofac Surg 4 : 142-147, 1993 https://doi.org/10.1097/00001665-199307000-00007
  21. Schulz RC : Reconstruction of facial deformities with alloplastic materials. Ann Plast Surg 7 : 434-446, 1981 https://doi.org/10.1097/00000637-198112000-00004
  22. Segal DH, Oppenheim JS, Murovic JA : Neurological recovery after cranioplasty. Neurosurgery 34: 729-731, 1994 https://doi.org/10.1227/00006123-199404000-00024
  23. Spector M, Flemming WR, Kreutner A : Bone growth into porous high-density polyethylene. J Biomed Master Res 10 : 595-603, 1976 https://doi.org/10.1002/jbm.820100416
  24. Vanaclocha V. Bazan A, Saiz-Sapena N, Palmoa V, Idoate M : Use of frozen cranial vault bone allograft in the repair of extensive cranial bone defect. Acta Neurochir (Wien) 139 : 653-660, 1997 https://doi.org/10.1007/BF01412001
  25. Wellisz T, Dougherty W, Gross J : Craniofacial applications for the Medpor porous polyethylene flexblock implant. J Craniofac Surg 3 : 101-107, 1992 https://doi.org/10.1097/00001665-199209000-00009
  26. YanaiA: Resin sealant: A new method of methyl methacrylate cranioplasty Technical note. J Neurosurg 75 : 328-330, 1991 https://doi.org/10.3171/jns.1991.75.2.0328