bruno zanotti - Academia.edu (original) (raw)

Papers by bruno zanotti

Research paper thumbnail of Craniotomy Burr Hole Covers: A Comparative Study of Biomechanical, Radiological, and Aesthetic Outcomes Using 3 Different Plug Materials

Journal of Craniofacial Surgery

Research paper thumbnail of Critical Evaluation of the Scientific Literature Concerning Bone Graft Alternatives in Spinal Surgery and Focus on Bioceramics

Surgical Technology Online

To improve solid spinal fusion while avoiding the morbidity associated with autograft harvesting ... more To improve solid spinal fusion while avoiding the morbidity associated with autograft harvesting procedures, numerous alternatives have been investigated, including allograft, demineralized bone matrix (DBM), cell-based therapies and growth factors (i.e., bone morphogenetic proteins, platelet concentrates), and ceramic-based biomaterials. Even though all of these approaches have the potential to improve the outcome of spinal fusion procedures, most of them have not yet been validated by evidence-based clinical results, and thus they are not strongly advisable for clinical use, in addition to being particularly expensive. Here, we give an overview of the current clinical evidence for bone graft alternatives for spine surgery procedures. We will also evaluate the pros and cons of their use and briefly review the more relevant literature.

Research paper thumbnail of The Antibiotic Immersion of Custom-Made Porous Hydroxyapatite Cranioplasty: A Multicentric Cohort Study

Journal of Craniofacial Surgery, 2022

ABSTRACT Cranioplasty is a common neurosurgical procedure performed to reconstruct cranial defect... more ABSTRACT Cranioplasty is a common neurosurgical procedure performed to reconstruct cranial defects. The most common cranioplasty materials used today can be divided into 2 types: autologous bone and bone substitutes, such as polyetheretherketone, titanium mesh, polymethyl methacrylate, and Hydroxyapatite (HA). Infection represents one of the most feared complications, ranging from 2.3% to 20%. Early implant infections occur within 30 days from the operation and are mostly due to pathogens from the skin and the paranasal cavity. The authors aim to demonstrate the efficacy of our preoperative antibiotic immersion protocol of custom-made HA prosthesis, to prevent early implant infections. The authors compare this population to cranioplasties without preoperative antibiotic elution and those with a nonstandardized antibiotic elution. The authors retrospectively analyzed data from patients referred to 6 different hospitals in northern Italy, in the period 2000 to 2020. Inclusion criteria were patients requiring reconstruction of thecal bone with HA prosthesis after post-traumatic decompressive surgery; age more than 18 years; detailed patient history and clinical data; and follow-up of minimum 6 months. A total of 77 cranioplasties were included in the study, along with 120 retrospective cases in comparison. Infections occurred in 2.6% of cranioplasties with antibiotic immersion compared to 7.8% of cranioplasties without. Even if nonsignificant, these results support our hypothesis that pretreatment of HA implants with antibiotic appears to prevent cranioplasty infections and could be a viable option to improve cranioplasty outcomes in the future.

Research paper thumbnail of Mono-Institutional

high-grade glioma, local recurrence.

Research paper thumbnail of Can the Elastic of Surgical Face Masks Stimulate Ear Protrusion in Children?

Aesthetic Plastic Surgery, 2020

In this period of the Covid-19 pandemic, a protective mask has become a common object of use to c... more In this period of the Covid-19 pandemic, a protective mask has become a common object of use to contain virus transmission. The imminent need for masks has led many governments to produce them, including surgical masks with elastic loops or masks with side cuts at the ears. Among those on the market, surgical masks with elastic loops are the ones most chosen by parents for their children. These elastics cause constant compression on the skin and, consequently, on the cartilage of the auricle, leading to erythematous and painful lesions of the retroauricular skin when the masks are used for many hours a day. Pre-adolescent children have undeveloped auricular cartilage with less resistance to deformation; prolonged pressure from the elastic loops of the mask at the hollow or, even worse, at the anthelix level can influence the correct growth and angulation of the outer ear. In fact, unlike when using conservative methods for the treatment of protruding ears, this prolonged pressure can increase the cephaloauricular angle of the outer auricle. It is important for the authorities supplying the masks to be aware of this potential risk and for alternative solutions to be found while maintaining the possibility of legitimate prevention of the potential spread of the virus.

Research paper thumbnail of Cranioplastiche Custom Made

Research paper thumbnail of Stereotactic Radiosurgery Maningiomas

Schmidek and sweet operative neurosurgical techniques: indications, methods, and results

Research paper thumbnail of Guidelines and Evidence-Based Recommendations for the Radiosurgical Treatment of CNS Meningiomas

Stereotactic Radiosurgery for the Treatment of Central Nervous System Meningiomas, 2021

Research paper thumbnail of La ricostruzione dello scalpo

Research paper thumbnail of Radiochirurgia con Gamma Knife nei meningiomi della fossa cranica posteriore. Risultati su 62 lesioni trattate

Research paper thumbnail of The importance of recognizing cerebral venous thrombosis following anti-COVID-19 vaccination

European Journal of Internal Medicine, 2021

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of Custom-Made Porous Hydroxyapatite Cranioplasty in Patients with Tumor Versus Traumatic Brain Injury: A Single-Center Case Series

World Neurosurgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Septic complication following porous hydroxyapatite cranioplasty: prosthesis retention management

Journal of neurosurgical sciences, Jan 13, 2016

After failing of autologous cranioplasty or when the bone flap is unavailable, the alloplastic (h... more After failing of autologous cranioplasty or when the bone flap is unavailable, the alloplastic (heterologous) materials are the choice for cranial reconstruction. No agreement has been reported about the material with a significant lower risk of septic complications. This is due to extremely heterogeneous prognostic factors related not only to the material used but also to the surgical procedures and/or to the timing of the procedure. More attention should be focused on the material whose characteristic could enable a delay in bacterial colonization, where an antibiotic therapy could be effective, without need of prosthesis removal. Four cases of severe septic complication following cranioplasty with porous hydroxyapatite (HA) prosthesis are presented. Patients were conservatively treated, without heterologous bone flap removal. All of our patients presented reasons for delaying HA cranioplasty removal: Patients 1, 3 and 4 had an associated shunted hydrocephalus and the need for non...

Research paper thumbnail of Surgical pitfalls with custom-made porous hydroxyapatite cranial implants

Plastic and Aesthetic Research, 2015

Aim: Cranioplasty implants are used primarily in cases of surgical cranial decompression followin... more Aim: Cranioplasty implants are used primarily in cases of surgical cranial decompression following pathological elevations of intracranial pressure. Available bone substitutes include porous hydroxyapatite (HA) and polymethylmethacrylate. Whichever material is used, however, prosthetic cranial implants are susceptible to intra-and postsurgical complications and even failure. The aim of this study was to investigate such occurrences in HA cranioplasty implants, seeking not only to determine the likely causes (whether correlated or not with the device itself) but also, where possible, to suggest countermeasures. Methods: We analyzed information regarding failures or complications reported in postmarketing surveillance and clinical studies of patients treated worldwide with custom-made HA cranial implants (Custom Bone Service Fin-Ceramica Faenza, Italy) in the period 1997-2013. Results: The two most common complications were implant fractures (84 cases, 2.9% of the total fitted) and infections (51 cases, 1.77%). Conclusion: Although cranioplasties are superficial and not difficult types of surgery, and use of custom-made implants are often considered the "easy" option from a surgical perspective, these procedures are nonetheless plagued by potential pitfalls. If performed well they yield more than satisfactory results from the points of view of both the patient and surgeon, but lack of appropriate care can open the door to numerous potential sources of failure, which can compromise-even irreparably-the ability to heal.

Research paper thumbnail of Giuro, senza ironia

Rivista di Neuroradiologia, 1992

Research paper thumbnail of Enhancing dermal and bone regeneration in calvarial defect surgery

Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India

To optimize the functional and esthetic result of cranioplasty, it is necessary to choose appropr... more To optimize the functional and esthetic result of cranioplasty, it is necessary to choose appropriate materials and take steps to preserve and support tissue vitality. As far as materials are concerned, custom-made porous hydroxyapatite implants are biomimetic, and therefore, provide good biological interaction and biointegration. However, before it is fully integrated, this material has relatively low mechanical resistance. Therefore, to reduce the risk of postoperative implant fracture, it would be desirable to accelerate regeneration of the tissues around and within the graft. The objective was to determine whether integrating growth-factor-rich platelet gel or supportive dermal matrix into hydroxyapatite implant cranioplasty can accelerate bone remodeling and promote soft tissue regeneration, respectively. The investigation was performed on cranioplasty patients fitted with hydroxyapatite cranial implants between 2004 and 2010. In 7 patients, platelet gel was applied to the bone...

Research paper thumbnail of Gamma Knife surgery in vestibular schwannomas: impact on the anterior and posterior labyrinth

Journal of neurosurgery, 2010

During the past decades, in small-to-medium size vestibular schwannomas, Gamma Knife surgery (GKS... more During the past decades, in small-to-medium size vestibular schwannomas, Gamma Knife surgery (GKS) has become a reliable therapeutic option because of either excellent local tumor control or minimal morbidity, with cranial neuropathy becoming increasingly rare. Although still insufficiently analyzed in larger cohorts of patients with long-term follow-ups, adequate chances of hearing preservation and vestibular sparing seem clinically guaranteed. However, deeper investigations are needed in this regard, expanding the number of cases and the follow-up period. A small group of patients with vestibular schwannomas (74 patients, including 41 men and 33 women) treated between 2003 and 2009 using GKS at the authors' institution were analyzed--both before and after GKS--with computerized static stabilometry and electronystagmography for balance disorders, vertigo, and ataxia on 1 side and pure tone average, vocal speech discrimination score, auditory brainstem response, and so forth for...

Research paper thumbnail of The efficacy of custom-made porous hydroxyapatite prostheses for cranioplasty: evaluation of postmarketing data on 2697 patients

Journal of applied biomaterials & functional materials, Jan 19, 2014

Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skull defects. A... more Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skull defects. Autologous bone is still considered the treatment of choice for cranioplasty. The aims of this study were to characterize and evaluate the efficacy of porous hydroxyapatite (HA) to fill skull defects based on its biomimetic characteristics. The authors analyzed the postmarketing data of all patients treated with custom-made porous HA prostheses (CustomBone Service). Characterization data in terms of physicochemical analysis and mechanical performance of the porous HA prostheses were also reported. The low incidence of adverse events (5.72%) due to the use of HA porous custom-made prostheses for cranioplasty is related to the biomimetic performance of the prostheses. The composition and morphology of the porosity enable it to be a useful biomimetic prosthesis for the reconstruction of large and complex skull defects, also able to promote osteointegration. These collected and analyzed data ...

Research paper thumbnail of Spontaneous fractures in custom-made porous hydroxyapatite cranioplasty implants: is fragility the only culprit?

Acta Neurochirurgica, 2015

Although the porous hydroxyapatite (PHA) used in custom-made cranioplasty implants is a material ... more Although the porous hydroxyapatite (PHA) used in custom-made cranioplasty implants is a material appreciated for its biomimetic properties, before osteointegration it is initially very fragile. Nevertheless, we wondered whether this primary fragility is entirely due to brittleness or whether the surgeon's actions may influence the behavior of the material. To study the influence of the surgeon's behavior, we made a virtual model of a custom-made PHA cranioplasty implant and submitted it to three implant procedural variables using finite element methods. In the first test, a scenario in which the surgeon's design, validation, and positioning techniques are impeccable, the edges of the implant adhered well to the craniectomy margins. In the second test, a discrepancy between a portion of the perimeter of the craniectomy and the profile of the prosthesis was modeled, and in the third test, several gaps were simulated between the implant and the craniectomy margins. Our mathematical model showed that when local and general discontinuities were included in the test scenarios, there was an increase in the load coming to bear on the cranioplasty implant, which amounted to 80 and 50 %, respectively. The fragility of custom-made PHA cranioplasty implants increases if the surgeon fails to achieve a precise design and validation, and/or an accurate surgical procedure. Nevertheless, careful attention during these phases helps to maintain the strength of the implant, given the more favorable mechanical conditions, without interfering with its biomimetic capacity.

Research paper thumbnail of Use of "custom made" porous hydroxyapatite implants for cranioplasty: postoperative analysis of complications in 1549 patients

Surgical Neurology International, 2013

Background: Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skul... more Background: Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skull defects, and should be considered the conclusion of a surgical act that began with bone flap removal. Autologous bone is still considered the treatment of choice for cranioplasty. An alternative choice is bioceramic porous hydroxyapatite (HA) as it is one of the materials that meets and comes closest to the biomimetic characteristics of bone. Methods: The authors analyzed the clinical charts, compiled by the neurosurgeon, of all patients treated with custom-made porous HA devices (Custom Bone Service Fin-Ceramica, Faenza) from which epidemiological and pathological data as well as material-related complications were extrapolated. Results: From November 1997 to December 2010, 1549 patients underwent cranioplasty with the implantation of 1608 custom-made porous HA devices. HA was used in 53.8% of patients for decompressive craniectomy after trauma or intracranial hemorrhage, while the remaining cases were for treated for comminuted fracture, cutaneous or osseous resection, cranial malformation, autologous bone reabsorption or infection or rejection of previously implanted material. The incidence of adverse events in patients treated for cranioplasty, as first line treatment was 4.78% (56 events/1171 patients), and 5.02%, (19 events/378 patients) at second line. Conclusion: This study demonstrates that HA is a safe and effective material, is well tolerated in both adult and pediatric patients, and meets the requirements necessary to repair craniolacunia.

Research paper thumbnail of Craniotomy Burr Hole Covers: A Comparative Study of Biomechanical, Radiological, and Aesthetic Outcomes Using 3 Different Plug Materials

Journal of Craniofacial Surgery

Research paper thumbnail of Critical Evaluation of the Scientific Literature Concerning Bone Graft Alternatives in Spinal Surgery and Focus on Bioceramics

Surgical Technology Online

To improve solid spinal fusion while avoiding the morbidity associated with autograft harvesting ... more To improve solid spinal fusion while avoiding the morbidity associated with autograft harvesting procedures, numerous alternatives have been investigated, including allograft, demineralized bone matrix (DBM), cell-based therapies and growth factors (i.e., bone morphogenetic proteins, platelet concentrates), and ceramic-based biomaterials. Even though all of these approaches have the potential to improve the outcome of spinal fusion procedures, most of them have not yet been validated by evidence-based clinical results, and thus they are not strongly advisable for clinical use, in addition to being particularly expensive. Here, we give an overview of the current clinical evidence for bone graft alternatives for spine surgery procedures. We will also evaluate the pros and cons of their use and briefly review the more relevant literature.

Research paper thumbnail of The Antibiotic Immersion of Custom-Made Porous Hydroxyapatite Cranioplasty: A Multicentric Cohort Study

Journal of Craniofacial Surgery, 2022

ABSTRACT Cranioplasty is a common neurosurgical procedure performed to reconstruct cranial defect... more ABSTRACT Cranioplasty is a common neurosurgical procedure performed to reconstruct cranial defects. The most common cranioplasty materials used today can be divided into 2 types: autologous bone and bone substitutes, such as polyetheretherketone, titanium mesh, polymethyl methacrylate, and Hydroxyapatite (HA). Infection represents one of the most feared complications, ranging from 2.3% to 20%. Early implant infections occur within 30 days from the operation and are mostly due to pathogens from the skin and the paranasal cavity. The authors aim to demonstrate the efficacy of our preoperative antibiotic immersion protocol of custom-made HA prosthesis, to prevent early implant infections. The authors compare this population to cranioplasties without preoperative antibiotic elution and those with a nonstandardized antibiotic elution. The authors retrospectively analyzed data from patients referred to 6 different hospitals in northern Italy, in the period 2000 to 2020. Inclusion criteria were patients requiring reconstruction of thecal bone with HA prosthesis after post-traumatic decompressive surgery; age more than 18 years; detailed patient history and clinical data; and follow-up of minimum 6 months. A total of 77 cranioplasties were included in the study, along with 120 retrospective cases in comparison. Infections occurred in 2.6% of cranioplasties with antibiotic immersion compared to 7.8% of cranioplasties without. Even if nonsignificant, these results support our hypothesis that pretreatment of HA implants with antibiotic appears to prevent cranioplasty infections and could be a viable option to improve cranioplasty outcomes in the future.

Research paper thumbnail of Mono-Institutional

high-grade glioma, local recurrence.

Research paper thumbnail of Can the Elastic of Surgical Face Masks Stimulate Ear Protrusion in Children?

Aesthetic Plastic Surgery, 2020

In this period of the Covid-19 pandemic, a protective mask has become a common object of use to c... more In this period of the Covid-19 pandemic, a protective mask has become a common object of use to contain virus transmission. The imminent need for masks has led many governments to produce them, including surgical masks with elastic loops or masks with side cuts at the ears. Among those on the market, surgical masks with elastic loops are the ones most chosen by parents for their children. These elastics cause constant compression on the skin and, consequently, on the cartilage of the auricle, leading to erythematous and painful lesions of the retroauricular skin when the masks are used for many hours a day. Pre-adolescent children have undeveloped auricular cartilage with less resistance to deformation; prolonged pressure from the elastic loops of the mask at the hollow or, even worse, at the anthelix level can influence the correct growth and angulation of the outer ear. In fact, unlike when using conservative methods for the treatment of protruding ears, this prolonged pressure can increase the cephaloauricular angle of the outer auricle. It is important for the authorities supplying the masks to be aware of this potential risk and for alternative solutions to be found while maintaining the possibility of legitimate prevention of the potential spread of the virus.

Research paper thumbnail of Cranioplastiche Custom Made

Research paper thumbnail of Stereotactic Radiosurgery Maningiomas

Schmidek and sweet operative neurosurgical techniques: indications, methods, and results

Research paper thumbnail of Guidelines and Evidence-Based Recommendations for the Radiosurgical Treatment of CNS Meningiomas

Stereotactic Radiosurgery for the Treatment of Central Nervous System Meningiomas, 2021

Research paper thumbnail of La ricostruzione dello scalpo

Research paper thumbnail of Radiochirurgia con Gamma Knife nei meningiomi della fossa cranica posteriore. Risultati su 62 lesioni trattate

Research paper thumbnail of The importance of recognizing cerebral venous thrombosis following anti-COVID-19 vaccination

European Journal of Internal Medicine, 2021

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of Custom-Made Porous Hydroxyapatite Cranioplasty in Patients with Tumor Versus Traumatic Brain Injury: A Single-Center Case Series

World Neurosurgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Septic complication following porous hydroxyapatite cranioplasty: prosthesis retention management

Journal of neurosurgical sciences, Jan 13, 2016

After failing of autologous cranioplasty or when the bone flap is unavailable, the alloplastic (h... more After failing of autologous cranioplasty or when the bone flap is unavailable, the alloplastic (heterologous) materials are the choice for cranial reconstruction. No agreement has been reported about the material with a significant lower risk of septic complications. This is due to extremely heterogeneous prognostic factors related not only to the material used but also to the surgical procedures and/or to the timing of the procedure. More attention should be focused on the material whose characteristic could enable a delay in bacterial colonization, where an antibiotic therapy could be effective, without need of prosthesis removal. Four cases of severe septic complication following cranioplasty with porous hydroxyapatite (HA) prosthesis are presented. Patients were conservatively treated, without heterologous bone flap removal. All of our patients presented reasons for delaying HA cranioplasty removal: Patients 1, 3 and 4 had an associated shunted hydrocephalus and the need for non...

Research paper thumbnail of Surgical pitfalls with custom-made porous hydroxyapatite cranial implants

Plastic and Aesthetic Research, 2015

Aim: Cranioplasty implants are used primarily in cases of surgical cranial decompression followin... more Aim: Cranioplasty implants are used primarily in cases of surgical cranial decompression following pathological elevations of intracranial pressure. Available bone substitutes include porous hydroxyapatite (HA) and polymethylmethacrylate. Whichever material is used, however, prosthetic cranial implants are susceptible to intra-and postsurgical complications and even failure. The aim of this study was to investigate such occurrences in HA cranioplasty implants, seeking not only to determine the likely causes (whether correlated or not with the device itself) but also, where possible, to suggest countermeasures. Methods: We analyzed information regarding failures or complications reported in postmarketing surveillance and clinical studies of patients treated worldwide with custom-made HA cranial implants (Custom Bone Service Fin-Ceramica Faenza, Italy) in the period 1997-2013. Results: The two most common complications were implant fractures (84 cases, 2.9% of the total fitted) and infections (51 cases, 1.77%). Conclusion: Although cranioplasties are superficial and not difficult types of surgery, and use of custom-made implants are often considered the "easy" option from a surgical perspective, these procedures are nonetheless plagued by potential pitfalls. If performed well they yield more than satisfactory results from the points of view of both the patient and surgeon, but lack of appropriate care can open the door to numerous potential sources of failure, which can compromise-even irreparably-the ability to heal.

Research paper thumbnail of Giuro, senza ironia

Rivista di Neuroradiologia, 1992

Research paper thumbnail of Enhancing dermal and bone regeneration in calvarial defect surgery

Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India

To optimize the functional and esthetic result of cranioplasty, it is necessary to choose appropr... more To optimize the functional and esthetic result of cranioplasty, it is necessary to choose appropriate materials and take steps to preserve and support tissue vitality. As far as materials are concerned, custom-made porous hydroxyapatite implants are biomimetic, and therefore, provide good biological interaction and biointegration. However, before it is fully integrated, this material has relatively low mechanical resistance. Therefore, to reduce the risk of postoperative implant fracture, it would be desirable to accelerate regeneration of the tissues around and within the graft. The objective was to determine whether integrating growth-factor-rich platelet gel or supportive dermal matrix into hydroxyapatite implant cranioplasty can accelerate bone remodeling and promote soft tissue regeneration, respectively. The investigation was performed on cranioplasty patients fitted with hydroxyapatite cranial implants between 2004 and 2010. In 7 patients, platelet gel was applied to the bone...

Research paper thumbnail of Gamma Knife surgery in vestibular schwannomas: impact on the anterior and posterior labyrinth

Journal of neurosurgery, 2010

During the past decades, in small-to-medium size vestibular schwannomas, Gamma Knife surgery (GKS... more During the past decades, in small-to-medium size vestibular schwannomas, Gamma Knife surgery (GKS) has become a reliable therapeutic option because of either excellent local tumor control or minimal morbidity, with cranial neuropathy becoming increasingly rare. Although still insufficiently analyzed in larger cohorts of patients with long-term follow-ups, adequate chances of hearing preservation and vestibular sparing seem clinically guaranteed. However, deeper investigations are needed in this regard, expanding the number of cases and the follow-up period. A small group of patients with vestibular schwannomas (74 patients, including 41 men and 33 women) treated between 2003 and 2009 using GKS at the authors' institution were analyzed--both before and after GKS--with computerized static stabilometry and electronystagmography for balance disorders, vertigo, and ataxia on 1 side and pure tone average, vocal speech discrimination score, auditory brainstem response, and so forth for...

Research paper thumbnail of The efficacy of custom-made porous hydroxyapatite prostheses for cranioplasty: evaluation of postmarketing data on 2697 patients

Journal of applied biomaterials & functional materials, Jan 19, 2014

Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skull defects. A... more Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skull defects. Autologous bone is still considered the treatment of choice for cranioplasty. The aims of this study were to characterize and evaluate the efficacy of porous hydroxyapatite (HA) to fill skull defects based on its biomimetic characteristics. The authors analyzed the postmarketing data of all patients treated with custom-made porous HA prostheses (CustomBone Service). Characterization data in terms of physicochemical analysis and mechanical performance of the porous HA prostheses were also reported. The low incidence of adverse events (5.72%) due to the use of HA porous custom-made prostheses for cranioplasty is related to the biomimetic performance of the prostheses. The composition and morphology of the porosity enable it to be a useful biomimetic prosthesis for the reconstruction of large and complex skull defects, also able to promote osteointegration. These collected and analyzed data ...

Research paper thumbnail of Spontaneous fractures in custom-made porous hydroxyapatite cranioplasty implants: is fragility the only culprit?

Acta Neurochirurgica, 2015

Although the porous hydroxyapatite (PHA) used in custom-made cranioplasty implants is a material ... more Although the porous hydroxyapatite (PHA) used in custom-made cranioplasty implants is a material appreciated for its biomimetic properties, before osteointegration it is initially very fragile. Nevertheless, we wondered whether this primary fragility is entirely due to brittleness or whether the surgeon's actions may influence the behavior of the material. To study the influence of the surgeon's behavior, we made a virtual model of a custom-made PHA cranioplasty implant and submitted it to three implant procedural variables using finite element methods. In the first test, a scenario in which the surgeon's design, validation, and positioning techniques are impeccable, the edges of the implant adhered well to the craniectomy margins. In the second test, a discrepancy between a portion of the perimeter of the craniectomy and the profile of the prosthesis was modeled, and in the third test, several gaps were simulated between the implant and the craniectomy margins. Our mathematical model showed that when local and general discontinuities were included in the test scenarios, there was an increase in the load coming to bear on the cranioplasty implant, which amounted to 80 and 50 %, respectively. The fragility of custom-made PHA cranioplasty implants increases if the surgeon fails to achieve a precise design and validation, and/or an accurate surgical procedure. Nevertheless, careful attention during these phases helps to maintain the strength of the implant, given the more favorable mechanical conditions, without interfering with its biomimetic capacity.

Research paper thumbnail of Use of "custom made" porous hydroxyapatite implants for cranioplasty: postoperative analysis of complications in 1549 patients

Surgical Neurology International, 2013

Background: Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skul... more Background: Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skull defects, and should be considered the conclusion of a surgical act that began with bone flap removal. Autologous bone is still considered the treatment of choice for cranioplasty. An alternative choice is bioceramic porous hydroxyapatite (HA) as it is one of the materials that meets and comes closest to the biomimetic characteristics of bone. Methods: The authors analyzed the clinical charts, compiled by the neurosurgeon, of all patients treated with custom-made porous HA devices (Custom Bone Service Fin-Ceramica, Faenza) from which epidemiological and pathological data as well as material-related complications were extrapolated. Results: From November 1997 to December 2010, 1549 patients underwent cranioplasty with the implantation of 1608 custom-made porous HA devices. HA was used in 53.8% of patients for decompressive craniectomy after trauma or intracranial hemorrhage, while the remaining cases were for treated for comminuted fracture, cutaneous or osseous resection, cranial malformation, autologous bone reabsorption or infection or rejection of previously implanted material. The incidence of adverse events in patients treated for cranioplasty, as first line treatment was 4.78% (56 events/1171 patients), and 5.02%, (19 events/378 patients) at second line. Conclusion: This study demonstrates that HA is a safe and effective material, is well tolerated in both adult and pediatric patients, and meets the requirements necessary to repair craniolacunia.