Download PDF
OP-Journal 2017; 33(01): 49-55
DOI: 10.1055/s-0042-123097
Fachwissen
Georg Thieme Verlag KG Stuttgart · New York

Kranioplastiken: Indikationen und Materialien

Cranioplasties: Indications and Materials
Thomas Kapapa
,
Christian Rainer Wirtz
,
Peter Richter
Further Information

Publication History

Publication Date:
23 June 2017 (online)

   Permissions and Reprints

Zusammenfassung

Nach Trauma, Infektionen oder Operationen kann es zu kleineren oder größeren Knochensubstanzdefekten am Gesichts- oder Hirnschädel kommen. Kleinere Knochendefekte stellen für das Hirn keine Gefahr dar, auch nicht bei diffusen Traumen, und zeigen keinen Einfluss auf den neurologischen Status. Dennoch ist der Verschluss größerer Knochenlücken am Schädel aus protektiven, kosmetischen und therapeutischen Erwägungen angezeigt. Besonders das „Syndrom des Trepanierten“ oder „Sinking-Skin-Flap-Syndrom“ mit Kopfschmerzen, Übelkeit, Erbrechen, Krampfanfällen und psychischen sowie psychologischen Auffälligkeiten nach Teilentfernung der Schädeldecke zeigt ein gutes Ansprechen auf den Verschluss. Es gibt Hinweise darauf, dass Kranioplastiken bereits seit Tausenden von Jahren durchgeführt wurden. Was einst als Einbringen eines Fremdkörpers in eine Knochenlücke begann, entwickelte sich zu einem mehrzeitigen, mehrregionalen, komplexen fazioorbitokranialen Eingriff. In dieser Entwicklung spielten über die Jahrhunderte hinweg kriegerische Auseinandersetzungen, von Handgreiflichkeiten bis hin zu moderner Militärtechnologie, in der Entstehung von Schädel-Hirn-Traumen und deren rekonstruktiven Therapien eine große Rolle. Während die letzten Jahrhunderte davon geprägt waren, das richtige Material zur Schädelplastik zu identifizieren, führt nun der weitere Weg über computerassistiertes Design zur zellmodulierenden und somit knochenverschließenden Technik.

Abstract

Trauma, infection or surgery may lead to minor or major bone defects in the cranium. Smaller bone defects may not represent a risk to the brain, even in diffuse trauma, and do not affect the neurological status. However, the closure of large bone gaps on the skull is indicated for protective, cosmetic and therapeutic reasons. In particular, the “syndrome of trephined” or “sinking skin flap syndrome” is accompanied by headache, nausea, vomiting, seizures, mental and psychological abnormalities after partial removal of the skull and shows a good response to closure. There are indications that cranioplasty has been performed for thousands of years. What began as introducing a foreign body into a bone gap developed into multiple regional and complex facio-orbito-cranial operations. Over the centuries, armed conflict, ranging from fisticuffs to modern military technology, has played a large role in the development of cranio-cerebral trauma and the corresponding reconstructive therapies. In the past centuries it was highly important to identify the right material for cranioplasty. Modern procedures are based on computer-assisted design. Further investigation may lead to techniques for cell modulation and bone occlusion.

 

  • Literatur

  • 1 Andrushko VA, Verano JW. Prehistoric trepanation in the Cuzco region of Peru: a view into an ancient Andean practice. Am J Phys Anthropol 2008; 137: 4-13
    CrossrefPubMedGoogle Scholar
  • 2 Kennedy KAR. Primitive surgery: skills before science. Am Anthropol 1987; 89: 217-218
    CrossrefPubMedGoogle Scholar
  • 3 Rifkinson-Mann S. Cranial surgery in ancient Peru. Neurosurgery 1988; 23: 411-416
    CrossrefPubMedGoogle Scholar
  • 4 Sanan A, Haines SJ. Repairing holes in the head: a history of cranioplasty. Neurosurgery 1997; 40: 588-603
    PubMedGoogle Scholar
  • 5 Bonfield CM, Kumar AR, Gerszten PC. The history of military cranioplasty. Neurosurg Focus 2014; 36: E18
    PubMedGoogle Scholar
  • 6 Goldstein JA, Paliga JT, Bartlett SP. Cranioplasty: indications and advances. Curr Opin Otolaryngol Head Neck Surg 2013; 21: 400-409
    CrossrefPubMedGoogle Scholar
  • 7 Courville CB. Cranioplasty in prehistoric times. Bull Los Angel Neuro Soc 1959; 24: 1-8
    PubMedGoogle Scholar
  • 8 Busch J. Trepanation seit dem Beginn der modernen Chirurgie. Ciba Zeitschrift 1936; 39
    PubMedGoogle Scholar
  • 9 Delashaw JB, Persing JA. Repair of cranial Defects. In: Winn R, Youmans R. eds. Neurological Surgery. Philadelphia: WB Saunders; 1996: 1853-1864
    Google Scholar
  • 10 Gardner WJ. Closure of defects of the skull with tantalum. Surg Gynecol Obstet 1945; 80: 303-312
    PubMedGoogle Scholar
  • 11 Grantham EG. Cranioplasty and the post-traumatic syndrome. J Neurosurg 1948; 5: 19-22
    CrossrefPubMedGoogle Scholar
  • 12 Gladstone HB, McDermott MW, Cooke DD. Implants for cranioplasty. Otolaryngol Clin North Am 1995; 28: 381-400
    PubMedGoogle Scholar
  • 13 Dujovny M, Aviles A, Agner C. et al. Cranioplasty: cosmetic or therapeutic?. Surg Neurol 1997; 47: 238-241
    CrossrefPubMedGoogle Scholar
  • 14 Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev 2006; (01) CD003983
    PubMedGoogle Scholar
  • 15 Vahedi K, Hofmeijer J, Juettler E. et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007; 6: 215-222
    CrossrefPubMedGoogle Scholar
  • 16 Kapapa T, Brand C, Wirtz CR. et al. Outcome after decompressive craniectomy in different pathologies. World Neurosurg 2016; 93: 389-397
    CrossrefPubMedGoogle Scholar
  • 17 Shah AM, Jung H, Skirboll S. Materials used in cranioplasty: a history and analysis. Neurosurg Focus 2014; 36: E19
    CrossrefPubMedGoogle Scholar
  • 18 Aydin S, Kucukyuruk B, Abuzayed B. et al. Cranioplasty: Review of materials and techniques. J Neurosci Rural Pract 2011; 2: 162-167
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Jelcic N, Della Puppa A, Mottaran R. et al. Case series evidence for improvement of executive functions after late cranioplasty. Brain Inj 2013; 27: 1723-1726
    CrossrefPubMedGoogle Scholar
  • 20 Grant GA, Jolley M, Ellenbogen RG. et al. Failure of autologous bone-assisted cranioplasty following decompressive craniectomy in children and adolescents. J Neurosurg 2004; 100 (2 Suppl Pediatrics): S163-S168
    PubMedGoogle Scholar
  • 21 Schorl M. Sinking skin flap syndrome (SSFS) – clinical spectrum and impact on rehabilitation. Cent Eur Neurosurg 2009; 70: 68-72
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Durand JL, Renier D, Marchac D. [The history of cranioplasty]. Ann Chir Plast Esthet 1997; 42: 75-83
    PubMedGoogle Scholar
  • 23 Kulali A, Kayaalp S. Single-table autogenous calvarial grafting for cranioplasty. J Craniomaxillofac Surg 1991; 19: 208-211
    CrossrefPubMedGoogle Scholar
  • 24 Grant FC, Norcross NC. Repair of cranial defects by cranioplasty. Ann Surg 1939; 110: 488-512
    CrossrefPubMedGoogle Scholar
  • 25 Inamasu J, Kuramae T, Nakatsukasa M. Does difference in the storage method of bone flaps after decompressive craniectomy affect the incidence of surgical site infection after cranioplasty? Comparison between subcutaneous pocket and cryopreservation. J Trauma 2010; 68: 183-187
    CrossrefPubMedGoogle Scholar
  • 26 Koenig WJ, Donovan JM, Pensler JM. Cranial bone grafting in children. Plast Reconstr Surg 1995; 95: 1-4
    CrossrefPubMedGoogle Scholar
  • 27 Booth JA, Curtis BF. I. Report of a case of tumor of the left frontal lobe of the cerebrum; operation; recovery. Ann Surg 1893; 17: 127-139
    CrossrefPubMedGoogle Scholar
  • 28 Fulcher OH. Tantalum as a metallic implant to repair cranial deficits. JAMA 1943; 121: 931-933
    CrossrefPubMedGoogle Scholar
  • 29 Matsuno A, Tanaka H, Iwamuro H. et al. Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochir (Wien) 2006; 148: 535-540
    CrossrefPubMedGoogle Scholar
  • 30 Lethaus B, Safi Y, ter Laak-Poort M. et al. Cranioplasty with customized titanium and PEEK implants in a mechanical stress model. J Neurotrauma 2012; 29: 1077-1083
    CrossrefPubMedGoogle Scholar
  • 31 Woodhall B, Spurling RG. Tantalum cranioplasty for war wounds of the skull. Ann Surg 1945; 121: 649-668
    CrossrefPubMedGoogle Scholar
  • 32 Henry HM, Guerrero CMoody RA. Cerebrospinal fluid fistula from fractured acrylic cranioplasty plate. Case report. J Neurosurg 1976; 45: 227-228
    CrossrefPubMedGoogle Scholar
  • 33 Galicich JH, Hovind KH. Stainless steel mesh-acrylic cranioplasty. Technical note. J Neurosurg 1967; 27: 376-378
    CrossrefPubMedGoogle Scholar
  • 34 Blum KS, Schneider SJ, Rosenthal AD. Methyl methacrylate cranioplasty in children: long-term results. Pediatr Neurosurg 1997; 26: 33-35
    CrossrefPubMedGoogle Scholar
  • 35 Klinger DR, Madden C, Beshay J. et al. Autologous and acrylic cranioplasty: a review of 10 years and 258 cases. World Neurosurg 2014; 82: e525-e530
    CrossrefPubMedGoogle Scholar
  • 36 Yadla S, Campbell PG, Chitale R. et al. Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review. Neurosurgery 2011; 68: 1124-1129
    CrossrefPubMedGoogle Scholar
  • 37 Bhaskar IP, Inglis TJ, Lee GY. Clinical, radiological, and microbiological profile of patients with autogenous cranioplasty infections. World Neurosurg 2014; 82: e531-e534
    CrossrefPubMedGoogle Scholar
  • 38 Rotaru H, Stan H, Florian IS. et al. Cranioplasty with custom-made implants: analyzing the cases of 10 patients. J Oral Maxillofac Surg 2012; 70: e169-e176
    CrossrefPubMedGoogle Scholar
  • 39 Chim H, Schantz JT. New frontiers in calvarial reconstruction: integrating computer-assisted design and tissue engineering in cranioplasty. Plast Reconstr Surg 2005; 116: 1726-1741
    CrossrefPubMedGoogle Scholar