Taylored implants for alloplastic cranioplasty--clinical and surgical considerations

Traumatic loss of bone substance or post - decompression defects require the reconstruction of the skull. In cases of simple geometry there are handy, secure and cost effective procedures such as using autologuous cryopreserved bone flaps or polymerized Methylmethacrylat. For large sized defects CAD - taylored implants developed to provide a comfortable procedure to ensure high biocompatibility and perfect anatomical results by one - stage surgery. Furthermore cranioplasty does not only imply anatomical reconstruction but also functional recovery of awareness, cognition and motoric functions as shown in several studies according to changes in cerebral hemodynamics and metabolism. In our series of 286 patients who underwent cranioplasty during the past 10 years (1993-2003) we used taylored implants in 15 cases starting in 1999. All the patients included showed large sized defects > 64 cm2, complications did not occur neither during surgery nor the postoperative course, cosmetical results were excellent in all the patients. Neurological findings and the functional state improved in 11/15 patients, 4/15 patients showed no change, nevertheless these patients had reached a good recovery before surgery. Application of this technique is limited by cost, nonetheless it is recommended for extensive reconstruction of the skull.