Cosmetic outcomes of cranioplasty using individual titanium implants

Abstract

The cosmetic outcome of cranioplasty performed with individual implants is an important component in assessing the results of surgical reconstructions of scull defects. Developing temporalis muscle atrophy affects the harmonic face contour and, in cases of using patient-specific implants (PSI), designed taking into account bone symmetry, may discredit this technique due to unsatisfactory cosmetic results. In this regard, an urgent task is to find the possibility of compensating for a visual defect by modifying the shape of individual implants in order to achieve good cosmetic results. 54 cases of performed cranioplasty were divided into two groups: in the first group (n=32), the implant was modeled symmetrically to the intact side of the skull; in the second group (n=22), the curvature of the plates was modified to compensate for the developing temporalis muscle atrophy. To standardize the zone potentially responsible for the temporal muscle atrophy, a refining marking of the KrÖnlein-Bryusova scheme was carried out. To determine the optimal structural element that increases the strength of the plates in the area of their free edge, a number of load experiments were carried out in a specialized computer environment. Good cosmetic efficacy for periods of at least 6 months after the operation using symmetrical implants and localization of defects in the temporal region was noted in 68.7 % of cases, while with the use of modified implants this figure amounted to 100 %. The results of digital modeling have established that the rounding of the free edge is the optimal structural element that increases the strength of the plates. The developed approaches have a high potential for implementation in neurosurgical practice when performing cranioplasty in patients with defects of the skull bones localized in the temporal rectangle zone.