Comparison between hand and custom-made cranial valut reconstruction: a retrospective study

Since there are no reports comparing hand and custom-made cranioplastics, a retrospective study was performed in order to detect those variables statistically associated to clinical failures. From January 2007 to December 2010, 67 patients (31M/36F; age range 17-82) operated at the Neurosurgery Unit of the Arcispedale S. Anna of the University Hospital of Ferrara, Italy were eligible for this retrospective study. The causes of primary operation were 34 (50.7%) cerebral hemorrhages, 24 (35.8%) traumas, 8 (11.9%) tumors and 1 (1.5%) infection, respectively. Hypertension was a co-morbidity factor in 23 (34.3%) patients. Hypertension was a co-morbidity factor in 23 (34.3%) patients. Cranial vault reconstruction was performed after a mean period of 7 months. The variables analyzed were causes of craniotomy (hemorrhages, traumas, tumors and infections), co-morbidity factor (i.e. hypertension), sites (3 frontal, 12 fronto-temporal, 42 fronto-temporo-parietal, 3 temporo-parietal and 3 temporo-occipito-parietal) and dimension of the defect (maximum diameter smaller than 9 cm, 9 <= x < 12 cm, equal or greater than 12 cm). Each patient obtained an excellent aesthetic result. There was no reabsorption, rejections or spontaneous fractures. In two cases the reconstruction was removed in the follow-up period: one case of infected reconstruction and case of mobility of the prosthesis. The overall survival rate was 97%, whereas hand and custom-made SVR were 100% and 95.5%, respectively: thus it was demonstrated that these surgical techniques are safe. PMMA prosthesis is a valid alternative to traditional cranioplasty techniques both aesthetically and in terms of absence of infections / rejections