gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Article

Send article

Casting mold cranioplasty from autologous bone flap in osteomyelitis and tumor infiltration

Meeting Abstract

Search Medline for

  • F. Stockhammer - Klinik für Neurochirurgie, Universitätsmedizin Göttingen; Abteilung für Neurochirurgie, Universitätsmedizin Rostock
  • F. Freimann - Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin
  • T. Schulz - Klinik für Neurochirurgie, Vivantes Klinikum Neukölln, Berlin
  • M. Misch - Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin
  • V. Rohde - Klinik für Neurochirurgie, Universitätsmedizin Göttingen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.13.03

doi: 10.3205/12dgnc279, urn:nbn:de:0183-12dgnc2792

Published: June 4, 2012

© 2012 Stockhammer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: After bone flap osteomyelitis or tumor infiltration skull closure needs to be done by inserting an artificial implant. Free-hand shaped PMMA plastics are cheap, but reveal questionable cosmetic results in larger defects. CAD CAM implants are cosmetically excellent, but highly expensive. We are presenting our first experiences with a technique of a casting mold cranioplasty.

Methods: In cases of bone flap osteomyelitis, the bone flap was extracted and kept until the wound closure. Than the flap was cleaned, burr hole defects were filled with bone wax and a cast with PMMA bone cement was molded on the outer side of the flap and the around the sides. After complete polymerisation the bone was removed and discarded. The cast was cleaned and kept until the patient was scheduled for cranioplasty after a couple of month. Before surgery for cranioplasty, the cast was sterilized (134° C for 15 min). The final implant was molded by filling the soft PMMA in the cast. The cast was than discarded and the implant fixed with plates or rivets. In cases of flap removal due to tumor infiltration, the unsterile procedure of cast molding was done under sterile conditions. All patients received postoperative CT control with 3D reconstruction. Patients were queried for cosmetic results after a follow-up of 6 weeks.

Results: In 11 patients, PMMA casts were made after revision for bone flap osteomyelitis. Cranioplasty had been performed in five of these cases. In two patients with tumor infiltration of the flap, cranioplasty was performed during the same operation. The craniotomies were pterional in 4, frontal in 1 and parietal in 2 cases. The median diameter of the defect was 6.5 cm (range 4–12.6 cm). A CT scan revealed a satisfactory form of the implant in all cases. All patients were content with the cosmetic result. In one patients with initial metastasis of a renal cell carcinoma and current sunitinib therapy, the implant had to be removed due to wound infection.

Conclusions: PMMA casting mold cranioplasty is a cheap and easy-to-perform technique with satisfactory cosmetic results.