Customized acrylic implants for reconstruction of extensive skull defects: an exception approach for selected patients

ABSTRACT Objective: to present our experience in the surgical treatment of extensive skullcap defects with customized acrylic implants. Methods: we conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between 2004 and 2013. We carefully selected all patients and classified surgical results based on three scales (craniofacial esthetics, improvement of facial symmetry and need for additional surgery). Results: fifteen patients underwent cranioplasty with intraoperative acrylic implants, whether manually customized (46.67%) or made with prototyped three-dimensional biomodels (53.33%). There were two (13.33%) complications (one infection with implant withdrawal and one seroma). We considered the craniofacial aesthetics excellent (50%), the degree of improvement of craniofacial symmetry satisfactory (57.14%), and the overall mean of surgical results according to the need for new surgeries was 1.5±0.52. Conclusion: cranioplasties of patients with extensive skullcap defects should obey careful and predetermined criteria, both for selection and for the acrylic implant customization method.

摘要 目的：介绍本团队采用定制化丙烯酸酯植入物治疗大面积颅盖骨缺损的外科临床经验。方法：本研究对2004年至2013年间接受丙烯酸酯颅骨成形术的大面积颅骨缺损患者开展回顾性分析，严格筛选所有入组病例，并基于三项评价标准（颅面部美学效果、面部对称性改善程度及是否需要再次手术）对手术效果进行分级。结果：共15例患者接受术中丙烯酸酯植入物颅骨成形术，其中手工定制植入物者占46.67%，通过三维原型生物模型制作植入物者占53.33%。术后共出现2例并发症（发生率13.33%）：1例为伴植入物取出的感染，1例为血清肿。评估结果显示，颅面部美学效果优秀者占50%，颅面部对称性改善程度满意者占57.14%，依据再次手术需求评估的手术效果总体均值为1.5±0.52。结论：针对大面积颅盖骨缺损患者的颅骨成形术，无论在患者遴选还是丙烯酸酯植入物定制方法上，均应遵循严谨且预先设定的标准化准则。