From Reparative Surgery to Regenerative Surgery: State of the Art of Porous Hydroxyapatite in Cranioplasty (original) (raw)
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Surgical Neurology International, 2013
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.
Journal of applied biomaterials & functional materials, 2014
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 ...
World Neurosurgery, 2020
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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 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.
Asian Journal of Neurosurgery, 2020
Custom-made cranial implants facilitate the surgical reconstruction of destructive pathologies of the skull or extensive demolitive skull surgery. Customized cranioplasty allows for an immediate restoration of the functional integrity of the cranial defect (restitutio ad integrum), with excellent functional and esthetic outcome and a quick, safe, and simple procedure. In this context, bioceramics like hydroxyapatite (HA) claim high biocompatibility and bone-binding capability. The osteoconductive properties of the HA have been reported in animal models and humans. The purpose of this study is to demonstrate with radiological and histological examination and how HA prosthesis may integrate after their implantation showing data related to five patients that needed primary HA cranial reconstruction with secondary removal after few years. The histological examination showed neo-formed lamellar/trabecular bone tissue fragments accompanied by the amorphous reticular tissue (HA prosthesis)...
Repair of craniofacial defects with hydroxyapatite cement
Journal of oral and maxillofacial …, 1997
Purpose: The objective of this study was to evaluate the course of healing of craniofacial bone defects when filled with hydroxyapatite cement and to determine whether adding various percentages by weight of demineralized bone powder to the cement will result in ...
Hydroxyapatite cranioplasty: a retrospective evaluation of osteointegration in 17 cases
Acta Neurochirurgica, 2018
Background Cranial reconstruction with autologous bone is still the gold standard although several biomaterials are available to re-establish the integrity of the cranial vault. Due to their biological and morphological characteristics, hydroxyapatite implants show promising results in small clinical cohort studies, especially within the paediatric population. Its biocompatibility and osteoconductivity should allow the formation of osseous bridging at the skull-prosthesis interface. Objective To examine the possible occurrence of osteointegration and to quantify it. Methods A retrospective study of patients with a hydroxyapatite implant from 2010 to 2014 at our neurosurgical department was conducted. Demographic, surgical and radiological data were studied. A senior neuroradiologist, a staff member neurosurgeon and a resident neurosurgeon independently performed the radiological evaluation. A new software analysis technique was developed to objectively quantify the degree of osteointegration. Results Seventeen implants were evaluated with an average patient age of 39 years and a mean follow-up of 155 weeks. Through radiologic evaluation, osseous bridging was deemed higher than 50% in six prostheses and higher than 75% in three. In five patients, no osteointegration could be seen. The remaining patients exhibited sparse signs of osteointegration, estimated between 10 and 50%. Software analysis showed an average osteointegration ratio of 37.4% with a 400-HU filter and 27.3% with a 700-HU filter. Conclusion In this small retrospective study of cranial hydroxyapatite implants, osteointegration did occur and to a degree of more than 50% in 1/3 of the patients.
World neurosurgery, 2015
Custom-made porous hydroxyapatite (HA) implant (Fin-Ceramica, Faenza S.p.A.) is a biomimetic, osteoinductive material. Margin fusion at bone-implant edge, cell proliferation within implant pores, as well as osteintegration in animal model have already been described. Radiological, microtomographical and histological analyses were performed on two patients who underwent surgical explantation of cranial implants after post-operative complication. Primary devices explanted after two years showed areas of newly formed bone strictly osteointegrated with pores of the prosthesis. These prostheses showed focal zone of resorption in correspondence of the newly formed bone and no signs of inflammation or cytotoxicity were observed. A back-up prosthesis, explanted from the same patient after 6 months because of an infection did not show presence of newly formed bone both on the surface and in the internal part of the prosthesis. Custom-made porous HA implant is an osteoinductive material able ...
Porous hydroxyapatite as a bone graft substitute in maxillary augmentation
Journal of Cranio-Maxillofacial Surgery, 1988
Porous hydroxyapatite (IP200), formed b y conversion of the Poritidae porites exoskeleton, has pores averaging 230 pm and pore interconnections averaging 190 pm in diameter. In the distal radial diaphyses of 14 dogs, bilateral 7.5 x 20 mm cortical windows were created and fitted with 5 x 7.5 x 20 mm blocks of IP200 implants and iliac autografts. Both implanted and contralateral grafted radius specimens were retrieved at 3, 6, 12, 24, and 48 months. Unstained undecalcified sections were examined by microradiography and UV epi-illumination. Stained undecalcified sections were examined by light microscopy and quantitated by histometric methods. Implant specimens demonstrated good union and bone ingrowth at all time intervals.