CLINICAL RESEARCH AND DISCUSSION OF MODIFIED CRANIOPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 DUHongpeng , LIZefu , LIMeng , LILijun

Department of Neurosurgery, Affiliated Hospital of Binzhou Medical University, Binzhou Shandong, 256603, P. R. China;

Corresponding?author：

DUHongpeng, Email: lddhp@163.com

Keywords：

Decompress craniectomy; Bone chip marker; Cranioplasty; Temporal muscle reconstruction

DOI：

10.7507/1002-1892.20150178

Video：

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Objective To study and design a modified cranioplasty, and to explore the effectiveness so as to reduce the incidence rate of operative complications. Methods A total of 68 patients with craniocerebral trauma or hypertensive cerebral hemorrhage between August 2012 and March 2014 were selected and randomly divided into 2 groups. The standard decompress craniectomy and under-temporal cranioplasty were performed in 32 cases (group A), and several small bone chips were placed under-tempus during decompress craniectomy and then the shape of temporal muscle was designed and the temporal muscle was reconstructed at the attachment sites during cranioplasty in 36 cases (group B). No significant difference was found in gender, age, side of operation, cause of injury, time between injury and decompress craniectomy, and time between postoperation and cranioplasty between 2 groups (P>0.05). Then the postoperative complications were compared between the 2 groups. Results Primary healing of incision was obtained in all patients. The patients were followed up 12 months on average (range, 6-16 months) in 2 groups. The follow complications occurred in group A:4 cases of asymmetric appearance (12.50%), 12 cases of temporal muscle atrophy (37.50%), 6 cases of temporal pain and masticatory atonia (18.75%), 2 cases of epilepsy (6.25%), 9 cases of leakage of cerebrospinal fluid (28.13%), 1 case of cerebral contusion and laceration (3.13%), and 1 case of cerebral hemorrhage (3.13%);temporal muscle atrophy was observed in 2 cases (5.56%) and the rate of complication was significantly lower than that in group A (P<0.05). The symmetrical appearance of the skull and good function were achieved in the other patients having no complication. Conclusion New technique of setting bone chip markers during decompress craniectomy and reconstructing temporal muscle during cranioplasty can reduce the incidence of complications and thus it is an effective surgical procedure.

Citation： DUHongpeng, LIZefu, LIMeng, LILijun. CLINICAL RESEARCH AND DISCUSSION OF MODIFIED CRANIOPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(7): 822-825. doi: 10.7507/1002-1892.20150178 Copy

1.	Bender A,Heulin S,R?hrer S,et al.Early cranioplasty may improve outcome in neurological patients with decompressive craniectomy.Brain Inj,2013,27(9):1073-1079.
2.	Kung WM,Lin FH,Hsiao SH,et al.New reconstructive technologies after decompressive craniectomy in traumatic brain injury:the role of three-dimensional titanium mesh.J Neurotrauma,2012,29(11):2030-2037.
3.	Schuss P,Vatter H,Marquardt G,et al.Cranioplasty after decompressive craniectomy:the effect of timing on postoperative complications.J Neurotrauma,2012,29(6):1090-1095.
4.	Hoffmann B,Sepehrnia A.Taylored implants for alloplastic cranioplasty-clinical and surgical considerations.Acta Neurochir Suppl,2005,93:127-129.
5.	De Bonis P,Frassanito P,Mangiola A,et al.Cranial repair:how complicated is filling a "hole"? J Neurotrauma,2012,29(6):1071-1076.
6.	Wachter D,Reineke K,Behm T,et al.Cranioplasty after decompressive hemicraniectomy:underestimated surgery-associated complications? Clin Neurol Neurosurg,2013,115(8):1293-1297.
7.	游潮,尹浩.加強顱骨成形術的基礎與臨床研究.中華創傷雜志,2006,22(10):721-724.
8.	寧錦龍,黃劍峰,易椿均,等.顳肌下和顳肌外兩種顱骨修補術式的臨床療效對比.中國臨床神經外科雜志,2013,18(1):39-41.
9.	林琳,張永輝,昝向陽,等.顳肌外鈦網修補顱骨缺損37例.中華神經外科雜志,2010,26(5):461-462.
10.	王輝,劉萬榮,魏忠,等.顳肌下和顳肌外兩種顱骨修補術式的臨床療效對比.安徽醫藥,2014,18(2):302-304.
11.	李先松,陳治標.顳肌外和顳肌下顱骨修補術治療顱骨缺損57例效果觀察.實用醫院臨床雜志,2013,10(6):191-192.
12.	任大斌,童武松,郭義君,等.標準大骨瓣減壓術后顳肌下顱骨修補術27例.中華神經外科雜志,2014,30(2):181-182.
13.	張志福,徐國政,杜浩,等.顳肌下鈦網修補額顳部顱骨缺損50例.中國臨床神經外科雜志,2011,16(4):234-235.
14.	胡禮虹,尹寧,譚愛平,等.數字化成形鈦網修補顱骨缺損的效果評價.中國醫藥指南,2012,10(18):449-450.
15.	Di Rienzo A,Iacoangeli M,Alvaro L,et al.Autologous vascularized dural wrapping for temporalis muscle preservation and reconstruction afterdecompressive craniectomy:report of twenty-five cases.Neurol Med Chir (Tokyo),2013,53(9):590-595.
16.	Oikawa S,Mizuno M,Muraoka S,et al.Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy.Technical note.J Neurosurg,1996,84(2):297-299.
17.	田道鋒,鄒瑛,陳謙學,等.顳肌的解剖研究及翼點開顱術后顳肌萎縮的防治.中華神經外科雜志,2006,22(4):239-241.
18.	Kitano M,Taneda M.Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery.Neurosurgery,2004,54(3):653-660.
19.	楊杰,吳俊波,肖鋒,等.顳肌復位在標準大骨瓣減壓術后顱骨缺損修補中的應用研究.中華神經醫學雜志,2014,13(10):1048-1052.

1. Bender A,Heulin S,R?hrer S,et al.Early cranioplasty may improve outcome in neurological patients with decompressive craniectomy.Brain Inj,2013,27(9):1073-1079.
2. Kung WM,Lin FH,Hsiao SH,et al.New reconstructive technologies after decompressive craniectomy in traumatic brain injury:the role of three-dimensional titanium mesh.J Neurotrauma,2012,29(11):2030-2037.
3. Schuss P,Vatter H,Marquardt G,et al.Cranioplasty after decompressive craniectomy:the effect of timing on postoperative complications.J Neurotrauma,2012,29(6):1090-1095.
4. Hoffmann B,Sepehrnia A.Taylored implants for alloplastic cranioplasty-clinical and surgical considerations.Acta Neurochir Suppl,2005,93:127-129.
5. De Bonis P,Frassanito P,Mangiola A,et al.Cranial repair:how complicated is filling a "hole"? J Neurotrauma,2012,29(6):1071-1076.
6. Wachter D,Reineke K,Behm T,et al.Cranioplasty after decompressive hemicraniectomy:underestimated surgery-associated complications? Clin Neurol Neurosurg,2013,115(8):1293-1297.
7. 游潮,尹浩.加強顱骨成形術的基礎與臨床研究.中華創傷雜志,2006,22(10):721-724.
8. 寧錦龍,黃劍峰,易椿均,等.顳肌下和顳肌外兩種顱骨修補術式的臨床療效對比.中國臨床神經外科雜志,2013,18(1):39-41.
9. 林琳,張永輝,昝向陽,等.顳肌外鈦網修補顱骨缺損37例.中華神經外科雜志,2010,26(5):461-462.
10. 王輝,劉萬榮,魏忠,等.顳肌下和顳肌外兩種顱骨修補術式的臨床療效對比.安徽醫藥,2014,18(2):302-304.
11. 李先松,陳治標.顳肌外和顳肌下顱骨修補術治療顱骨缺損57例效果觀察.實用醫院臨床雜志,2013,10(6):191-192.
12. 任大斌,童武松,郭義君,等.標準大骨瓣減壓術后顳肌下顱骨修補術27例.中華神經外科雜志,2014,30(2):181-182.
13. 張志福,徐國政,杜浩,等.顳肌下鈦網修補額顳部顱骨缺損50例.中國臨床神經外科雜志,2011,16(4):234-235.
14. 胡禮虹,尹寧,譚愛平,等.數字化成形鈦網修補顱骨缺損的效果評價.中國醫藥指南,2012,10(18):449-450.
15. Di Rienzo A,Iacoangeli M,Alvaro L,et al.Autologous vascularized dural wrapping for temporalis muscle preservation and reconstruction afterdecompressive craniectomy:report of twenty-five cases.Neurol Med Chir (Tokyo),2013,53(9):590-595.
16. Oikawa S,Mizuno M,Muraoka S,et al.Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy.Technical note.J Neurosurg,1996,84(2):297-299.
17. 田道鋒,鄒瑛,陳謙學,等.顳肌的解剖研究及翼點開顱術后顳肌萎縮的防治.中華神經外科雜志,2006,22(4):239-241.
18. Kitano M,Taneda M.Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery.Neurosurgery,2004,54(3):653-660.
19. 楊杰,吳俊波,肖鋒,等.顳肌復位在標準大骨瓣減壓術后顱骨缺損修補中的應用研究.中華神經醫學雜志,2014,13(10):1048-1052.

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