Acta Neurochir (2015) 157:681–687 DOI 10.1007/s00701-015-2363-2
CLINICAL ARTICLE - PEDIATRICS
Paediatric cranial defect reconstruction using bioactive fibre-reinforced composite implant: early outcomes Jaakko M. Piitulainen & Jussi P. Posti & Kalle M. J. Aitasalo & Ville Vuorinen & Pekka K. Vallittu & Willy Serlo
Received: 3 December 2014 / Accepted: 22 January 2015 / Published online: 10 February 2015 # Springer-Verlag Wien 2015
Abstract Background In children, approximately half of cryopreserved allograft bone flaps fail due to infection and resorption. Synthetic materials offer a solution for allograft bone flap resorption. Fibre-reinforced composite with a bioactive glass particulate filling is a new synthetic material for bone reconstruction. Bioactive glass is capable of chemically bonding with bone and is osteoinductive, osteoconductive and bacteriostatic. Fibre-reinforced composite allows for fabricating thin (0.8 mm) margins for implant, which are designed as onlays on the existing bone. Bioactive glass is dissolved over time, whereas the fibre-reinforced composite serves as a biostable part of the implant, and these have been tested in preclinical and adult clinical trials. In this study, we tested the safety and other required properties of this composite material in large skull bone reconstruction with children. Presented at the 15th European Congress of Neurosurgery, in Prague, Czech Republic, 12-17 October 2014 J. M. Piitulainen (*) : K. M. J. Aitasalo Division of Surgery and Cancer Diseases, Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, PO Box 52, 20521 Turku, Finland e-mail: [email protected] J. P. Posti : V. Vuorinen Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland J. M. Piitulainen : P. K. Vallittu Department of Biomaterials Science and Turku Clinical Biomaterials Centre - TCBC, Institute of Dentistry, University of Turku, Turku, Finland P. K. Vallittu City of Turku Welfare Division, Oral Health Care, Turku, Finland W. Serlo Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
Method Eight cranioplasties were performed on seven patients, aged 2.5–16 years and having large (>16 cm2) skull bone defects. The implant used in this study was a patientspecific, glass-fibre-reinforced composite, which contained a bioactive glass particulate compound, S53P4. Results During follow-up (average 35.1 months), one minor complication was observed and three patients needed revision surgery. Two surgical site infections were observed. After treatment of complications, a good functional and cosmetic outcome was observed in all patients. The implants had an onlay design and fitted the defect well. In clinical and imaging examinations, the implants were in the original position with no signs of implant migration, degradation or mechanical breakage. Conclusions Here, we found that early cranioplasty outcomes with the fibre-reinforced composite implant were promising. However, a longer follow-up time and a larger group of patients are needed to draw firmer conclusions regarding the long-term benefits of the proposed novel biomaterial and implant design. The glass-fibre-reinforced composite implant incorporated by particles of bioactive glass may offer an original, non-metallic and bioactive alternative for reconstruction of large skull bone defects in a paediatric population. Keywords Cranioplasty . Craniectomy . Craniofacial bone reconstruction . Fibre-reinforced composite . FRC . Bioactive glass . Paediatric . Skull bone defect
Introduction Reconstruction of skull bone defects is challenging, especially in children. Skull bone defects can result from severe infection, trauma or tumour surgery and after decompressive craniotomy. At present, decompressive craniectomy is a standardised neurosurgical procedure for the management of
682
elevated intracranial pressure that is refractory to medical treatment even in paediatric cases [28, 30, 33]. The reconstruction of skull bone defects, cranioplasty, is needed to protect the brain and to normalise cerebral haemodynamics and metabolism [4]. Furthermore, cosmetic handicaps require reconstruction of the defect. Recent studies have revealed that reconstruction of large cranial defects is far from an uncomplicated procedure, especially in young patients. Infection of the cryopreserved bone and resorption of the bone flap is especially common in young patients [3, 7, 9, 10, 12, 22]. The primary method to reconstruct small and mediumsized skull bone defects (
CLINICAL ARTICLE - PEDIATRICS
Paediatric cranial defect reconstruction using bioactive fibre-reinforced composite implant: early outcomes Jaakko M. Piitulainen & Jussi P. Posti & Kalle M. J. Aitasalo & Ville Vuorinen & Pekka K. Vallittu & Willy Serlo
Received: 3 December 2014 / Accepted: 22 January 2015 / Published online: 10 February 2015 # Springer-Verlag Wien 2015
Abstract Background In children, approximately half of cryopreserved allograft bone flaps fail due to infection and resorption. Synthetic materials offer a solution for allograft bone flap resorption. Fibre-reinforced composite with a bioactive glass particulate filling is a new synthetic material for bone reconstruction. Bioactive glass is capable of chemically bonding with bone and is osteoinductive, osteoconductive and bacteriostatic. Fibre-reinforced composite allows for fabricating thin (0.8 mm) margins for implant, which are designed as onlays on the existing bone. Bioactive glass is dissolved over time, whereas the fibre-reinforced composite serves as a biostable part of the implant, and these have been tested in preclinical and adult clinical trials. In this study, we tested the safety and other required properties of this composite material in large skull bone reconstruction with children. Presented at the 15th European Congress of Neurosurgery, in Prague, Czech Republic, 12-17 October 2014 J. M. Piitulainen (*) : K. M. J. Aitasalo Division of Surgery and Cancer Diseases, Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, PO Box 52, 20521 Turku, Finland e-mail: [email protected] J. P. Posti : V. Vuorinen Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland J. M. Piitulainen : P. K. Vallittu Department of Biomaterials Science and Turku Clinical Biomaterials Centre - TCBC, Institute of Dentistry, University of Turku, Turku, Finland P. K. Vallittu City of Turku Welfare Division, Oral Health Care, Turku, Finland W. Serlo Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
Method Eight cranioplasties were performed on seven patients, aged 2.5–16 years and having large (>16 cm2) skull bone defects. The implant used in this study was a patientspecific, glass-fibre-reinforced composite, which contained a bioactive glass particulate compound, S53P4. Results During follow-up (average 35.1 months), one minor complication was observed and three patients needed revision surgery. Two surgical site infections were observed. After treatment of complications, a good functional and cosmetic outcome was observed in all patients. The implants had an onlay design and fitted the defect well. In clinical and imaging examinations, the implants were in the original position with no signs of implant migration, degradation or mechanical breakage. Conclusions Here, we found that early cranioplasty outcomes with the fibre-reinforced composite implant were promising. However, a longer follow-up time and a larger group of patients are needed to draw firmer conclusions regarding the long-term benefits of the proposed novel biomaterial and implant design. The glass-fibre-reinforced composite implant incorporated by particles of bioactive glass may offer an original, non-metallic and bioactive alternative for reconstruction of large skull bone defects in a paediatric population. Keywords Cranioplasty . Craniectomy . Craniofacial bone reconstruction . Fibre-reinforced composite . FRC . Bioactive glass . Paediatric . Skull bone defect
Introduction Reconstruction of skull bone defects is challenging, especially in children. Skull bone defects can result from severe infection, trauma or tumour surgery and after decompressive craniotomy. At present, decompressive craniectomy is a standardised neurosurgical procedure for the management of
682
elevated intracranial pressure that is refractory to medical treatment even in paediatric cases [28, 30, 33]. The reconstruction of skull bone defects, cranioplasty, is needed to protect the brain and to normalise cerebral haemodynamics and metabolism [4]. Furthermore, cosmetic handicaps require reconstruction of the defect. Recent studies have revealed that reconstruction of large cranial defects is far from an uncomplicated procedure, especially in young patients. Infection of the cryopreserved bone and resorption of the bone flap is especially common in young patients [3, 7, 9, 10, 12, 22]. The primary method to reconstruct small and mediumsized skull bone defects (
