• Kihlström Burenstam Linder Lars L Department of Neurosurgery, Clinical Neurosciences, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. Electro, Ulrik Birgersson, Kalle Lundgren, Christopher Illies, and Thomas Engstrand.
• Department of Neurosurgery, Clinical Neurosciences, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. Electronic address: lars.kihlstrom-burenstam-linder@sll.se.
• World Neurosurg. 2019 Feb 1; 122: e399-e407.

BackgroundThe reconstruction of complex cranial defects is challenging and is associated with a high complication rate. The development of a patient-specific, titanium-reinforced, calcium phosphate-based (CaP-Ti) implant with bone regenerative properties has previously been described in 2 case studies with the hypothesis that the implant may improve clinical outcome.ObjectiveTo identify whether the introduction of CaP-Ti implant has the potential to improve clinical outcome.MethodsA retrospective review of all patients having undergone CaP-Ti cranioplasty was conducted. Comprehensive clinical data were collected from the hospital computer database and patient records. Bone formation and osseointegration were analyzed in a single retrieval specimen.ResultsFifty patients, with 52 cranial defects, met the inclusion criteria. The patient cohort displayed a previous failure rate of 64% (32/50) with autologous bone, alloplastic materials, or both. At a median follow-up time of 25 months, the explantation rate due to either early postoperative infection or persistent wound dehiscence was 1.9% (1/53) or 3.8% (2/53), respectively. Surgical intervention with local wound revision was required in 2 patients without the need of implant removal. One patient had a brain tumor recurrence, and the implant was explanted 31 months after implantation. Histologic examination showed that the entire implant was partly yet evenly transformed into vascularized compact bone.ConclusionIn the present study the CaP-Ti implant appears to have improved the clinical outcomes in a cohort of patients with a high rate of previous cranioplasty failures. The bone regenerative effect may in particular have an impact on the long-term success rate of the implant.Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

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