The skull provides protection and mechanical support, and acts as a container for the brain and its accessory organs. Some defects in the skull can fatally threaten human life.Many efforts have been taken to repair de...The skull provides protection and mechanical support, and acts as a container for the brain and its accessory organs. Some defects in the skull can fatally threaten human life.Many efforts have been taken to repair defects in the skull, among which cranioplasty is the most prominent technique. To repair the injury, numerous natural and artificial materials have been adopted by neurosurgeons. Many cranioprostheses have been tried in the past decades, from autoplast to bioceramics. Neurosurgeons have been evaluating their advantages and shortages through clinical practice. Among those prostheses, surgeons gradually prefer bionic ones due to their marvelous osteoconductivity,osteoinductivity, biocompatibility, and biodegradability. Autogeneic bone has been widely recognized as the "gold standard" for renovating large-sized bone defects. However, the access to this technique is restricted by limited availability and complications associated with its use. Many metal and polymeric materials with mechanical characteristics analogous to natural bones were consequently applied to cranioplasty. But most of them were unsatisfactory concerning osteoconductiion and biodegradability owe to their intrinsic properties. With the microstructures almost identical to natural bones, mineralized collagen has biological performance nearly identical to autogeneic bone, such as osteoconduction. Implants made of mineralized collagen can integrate themselves into the newly formed bones through a process called "creeping substitution". In this review, the authors retrospect the evolution of skull repair material applied in cranioplasty. The ultimate skull repair material should have microstructure and bioactive qualities that enable osteogenesis induction and intramembranous ossification.展开更多
<strong>Rationale:</strong> The three-dimensional (3D) computer-made titanium mesh is widely used in the skull repair for those patients receiving decompression of the bone flap. It can restore normal anat...<strong>Rationale:</strong> The three-dimensional (3D) computer-made titanium mesh is widely used in the skull repair for those patients receiving decompression of the bone flap. It can restore normal anatomy to a greater extent and make a better appearance. <strong>Case Presentation: </strong>We reported two cases of patients admitted to our hospital who have experienced high scalp tension after skull repair. At first, these two patients underwent decompression of the bone flap, and the physical examination results showed a defect of skull. No neurological symptoms and signs were found. The 3D computed tomography (CT) reconstruction of skull was performed, and then the skull repair with 3D titanium mesh was conducted. But because of high scalp tension, they underwent a second operation, during which we re-trimmed and reduce the arc of the titanium mesh. The scalp incision of both patients healed well and no titanium mesh was exposed. Both patients have a good prognosis. <strong>Lessons:</strong> We highlight that the high tension of scalp due to overstretching after 3D titanium mesh repair for skull defect should be paid much attention to. Trimming and reducing the arc of titanium mesh is an effective treatment for this situation.展开更多
Objective To investigate the effect of repair of cranial deficiency on psychology of patients in rehabilitation stage. Method Apply organic glass or bony cement to repair the skull. Result 26 patients healed by first ...Objective To investigate the effect of repair of cranial deficiency on psychology of patients in rehabilitation stage. Method Apply organic glass or bony cement to repair the skull. Result 26 patients healed by first intention, and the psychological symptoms relieved obviously. Conclusion Repair of skull could not only reconstruct the cranial barrier, but also ameliorate some symptoms and psychological burden, which is benefit for the rehabilitation of patients.展开更多
Non-Hodgkin lymphoma involving the skull base is a very rare tumour. The role of surgery for these patients remains controversial, as is the use of dural graft for CSF leak repair. With an increasing incidence of CNS ...Non-Hodgkin lymphoma involving the skull base is a very rare tumour. The role of surgery for these patients remains controversial, as is the use of dural graft for CSF leak repair. With an increasing incidence of CNS lymphoma, more atypical presentations are reported. It is, therefore, important to include lymphoma in the differential diagnosis of skull base lesions as long-term remission is achievable for such patients, as shown in our case. Dural graft used for CSF leak repair could present with delayed complication mimicking tumour recurrence. Relevant published literature is reviewed.展开更多
目的探讨脑室-腹腔(V-P)分流术不同穿刺位置联合同期颅骨修补术在颅脑损伤脑积水患者中的效果及对凝血功能、粒系集落刺激因子(G-CSF)、肿瘤坏死因子-α(TNF-α)的影响。方法回顾性分析2020-06—2022-06晋城市人民医院121例颅脑损伤脑...目的探讨脑室-腹腔(V-P)分流术不同穿刺位置联合同期颅骨修补术在颅脑损伤脑积水患者中的效果及对凝血功能、粒系集落刺激因子(G-CSF)、肿瘤坏死因子-α(TNF-α)的影响。方法回顾性分析2020-06—2022-06晋城市人民医院121例颅脑损伤脑积水患者临床资料,根据手术方案分为A组(n=61)和B组(n=60),分别行V-P分流术(副三角区穿刺)+颅骨修补术、V-P分流术(侧脑室三角区穿刺)+颅骨修补术。统计2组脑积水改善情况、并发症、预后,对比术前、术后凝血功能、G-CSF、TNF-α、脑灌注情况、神经功能评分(NIHSS)。结果A组脑积水改善总有效率81.97%与B组80.00%比较,差异无统计学意义(P>0.05)。术后3 d、7 d A组血清APTT、PT水平低于B组,Fbg水平高于B组(P<0.05)。术后1个月A组血清G-CSF水平高于B组,TNF-α水平低于B组(P<0.05)。术前2组NIHSS评分、ICP、CCP比较,差异无统计学意义(P>0.05),术后1个月、3个月2组NIHSS评分、ICP低于术前,CCP高于术前(P<0.05)。A组并发症发生率(6.56%)低于B组(20.00%,P<0.05)。术后3个月,A组预后优良率(66.67%)与B组(67.24%)比较,差异无统计学意义(P>0.05)。结论V-P分流术不同穿刺位置联合同期颅骨修补术治疗颅脑损伤脑积水疗效相当,特别是副三角区穿刺,可减少并发症,降低血清G-CSF、TNF-α水平,且对凝血功能影响较小。展开更多
背景:神经内镜经鼻蝶手术因其微创、显露充分、术后恢复快等特点,已成为前颅底中线及侧颅底占位最常用的手术方式。随着手术范围及适应证也的不断扩展,颅底磨除范围相应增加,这也使术后脑脊液漏发生率也相应增高。严重的脑脊液漏可导致...背景:神经内镜经鼻蝶手术因其微创、显露充分、术后恢复快等特点,已成为前颅底中线及侧颅底占位最常用的手术方式。随着手术范围及适应证也的不断扩展,颅底磨除范围相应增加,这也使术后脑脊液漏发生率也相应增高。严重的脑脊液漏可导致患者致命性的颅内感染及极差的预后。因此在神经内镜手术后,可靠的颅底重建是手术成功的基本条件,文章以此对颅底重建原则、方法、颅底重建应用的不同材料的生物学特性等展开综述。目的:阐述颅底重建的原则方法,总结不同重建材料的研究进展及不同生物学特性在颅底重建中的作用。方法:计算机检索万方及PubMed数据库2012年1月至2022年1月收录的文献,中文检索词为“颅底重建、神经内镜、颅底骨缺损、经鼻蝶手术入路、多重修补、带蒂黏膜瓣、聚醚醚酮、羟基磷灰石”,英文检索词为“Skull base reconstruction,Neuroendoscopy,Skull base bone defect,Transnasal-sphenoidal operative approach,Multiple repair,Pedicled mucosal flap,Polyether-ether-ketone(PEEK),Hydroxylapatite”,最终纳入60篇文献进行综述。结果与结论:(1)神经内镜经鼻蝶术后,即使颅底缺损越来越大,颅底重建的目地依旧是预防脑脊液漏避免严重并发症,目前多层修补是一致认可的修复原则。(2)骨性支撑的类骨材料诸如聚醚醚酮、羟基磷灰石因为价格昂贵且术前准备繁琐,临床应用较少;临床医生多靠类硬膜结构的生物材料及带蒂黏膜瓣完成修补,但受限于修补支撑力弱及黏膜瓣血运情况,少数病患仍有一定概率存在脑脊液漏的风险。(3)因此,术中类硬膜、类骨结构人工生物材料以及带蒂黏膜瓣修补颅底缺损符合恢复颅底的解剖修复,有助于硬膜、骨质结构的再生,这样也使疏水组织-类硬膜结构-类骨结构-黏膜的一体化生物材料研发具有广阔的应用前景。展开更多
基金Supported by the National Natural Science Foundation of China(Nos.21371106 and 51402167)
文摘The skull provides protection and mechanical support, and acts as a container for the brain and its accessory organs. Some defects in the skull can fatally threaten human life.Many efforts have been taken to repair defects in the skull, among which cranioplasty is the most prominent technique. To repair the injury, numerous natural and artificial materials have been adopted by neurosurgeons. Many cranioprostheses have been tried in the past decades, from autoplast to bioceramics. Neurosurgeons have been evaluating their advantages and shortages through clinical practice. Among those prostheses, surgeons gradually prefer bionic ones due to their marvelous osteoconductivity,osteoinductivity, biocompatibility, and biodegradability. Autogeneic bone has been widely recognized as the "gold standard" for renovating large-sized bone defects. However, the access to this technique is restricted by limited availability and complications associated with its use. Many metal and polymeric materials with mechanical characteristics analogous to natural bones were consequently applied to cranioplasty. But most of them were unsatisfactory concerning osteoconductiion and biodegradability owe to their intrinsic properties. With the microstructures almost identical to natural bones, mineralized collagen has biological performance nearly identical to autogeneic bone, such as osteoconduction. Implants made of mineralized collagen can integrate themselves into the newly formed bones through a process called "creeping substitution". In this review, the authors retrospect the evolution of skull repair material applied in cranioplasty. The ultimate skull repair material should have microstructure and bioactive qualities that enable osteogenesis induction and intramembranous ossification.
文摘<strong>Rationale:</strong> The three-dimensional (3D) computer-made titanium mesh is widely used in the skull repair for those patients receiving decompression of the bone flap. It can restore normal anatomy to a greater extent and make a better appearance. <strong>Case Presentation: </strong>We reported two cases of patients admitted to our hospital who have experienced high scalp tension after skull repair. At first, these two patients underwent decompression of the bone flap, and the physical examination results showed a defect of skull. No neurological symptoms and signs were found. The 3D computed tomography (CT) reconstruction of skull was performed, and then the skull repair with 3D titanium mesh was conducted. But because of high scalp tension, they underwent a second operation, during which we re-trimmed and reduce the arc of the titanium mesh. The scalp incision of both patients healed well and no titanium mesh was exposed. Both patients have a good prognosis. <strong>Lessons:</strong> We highlight that the high tension of scalp due to overstretching after 3D titanium mesh repair for skull defect should be paid much attention to. Trimming and reducing the arc of titanium mesh is an effective treatment for this situation.
文摘Objective To investigate the effect of repair of cranial deficiency on psychology of patients in rehabilitation stage. Method Apply organic glass or bony cement to repair the skull. Result 26 patients healed by first intention, and the psychological symptoms relieved obviously. Conclusion Repair of skull could not only reconstruct the cranial barrier, but also ameliorate some symptoms and psychological burden, which is benefit for the rehabilitation of patients.
文摘Non-Hodgkin lymphoma involving the skull base is a very rare tumour. The role of surgery for these patients remains controversial, as is the use of dural graft for CSF leak repair. With an increasing incidence of CNS lymphoma, more atypical presentations are reported. It is, therefore, important to include lymphoma in the differential diagnosis of skull base lesions as long-term remission is achievable for such patients, as shown in our case. Dural graft used for CSF leak repair could present with delayed complication mimicking tumour recurrence. Relevant published literature is reviewed.
文摘目的探讨脑室-腹腔(V-P)分流术不同穿刺位置联合同期颅骨修补术在颅脑损伤脑积水患者中的效果及对凝血功能、粒系集落刺激因子(G-CSF)、肿瘤坏死因子-α(TNF-α)的影响。方法回顾性分析2020-06—2022-06晋城市人民医院121例颅脑损伤脑积水患者临床资料,根据手术方案分为A组(n=61)和B组(n=60),分别行V-P分流术(副三角区穿刺)+颅骨修补术、V-P分流术(侧脑室三角区穿刺)+颅骨修补术。统计2组脑积水改善情况、并发症、预后,对比术前、术后凝血功能、G-CSF、TNF-α、脑灌注情况、神经功能评分(NIHSS)。结果A组脑积水改善总有效率81.97%与B组80.00%比较,差异无统计学意义(P>0.05)。术后3 d、7 d A组血清APTT、PT水平低于B组,Fbg水平高于B组(P<0.05)。术后1个月A组血清G-CSF水平高于B组,TNF-α水平低于B组(P<0.05)。术前2组NIHSS评分、ICP、CCP比较,差异无统计学意义(P>0.05),术后1个月、3个月2组NIHSS评分、ICP低于术前,CCP高于术前(P<0.05)。A组并发症发生率(6.56%)低于B组(20.00%,P<0.05)。术后3个月,A组预后优良率(66.67%)与B组(67.24%)比较,差异无统计学意义(P>0.05)。结论V-P分流术不同穿刺位置联合同期颅骨修补术治疗颅脑损伤脑积水疗效相当,特别是副三角区穿刺,可减少并发症,降低血清G-CSF、TNF-α水平,且对凝血功能影响较小。
文摘背景:神经内镜经鼻蝶手术因其微创、显露充分、术后恢复快等特点,已成为前颅底中线及侧颅底占位最常用的手术方式。随着手术范围及适应证也的不断扩展,颅底磨除范围相应增加,这也使术后脑脊液漏发生率也相应增高。严重的脑脊液漏可导致患者致命性的颅内感染及极差的预后。因此在神经内镜手术后,可靠的颅底重建是手术成功的基本条件,文章以此对颅底重建原则、方法、颅底重建应用的不同材料的生物学特性等展开综述。目的:阐述颅底重建的原则方法,总结不同重建材料的研究进展及不同生物学特性在颅底重建中的作用。方法:计算机检索万方及PubMed数据库2012年1月至2022年1月收录的文献,中文检索词为“颅底重建、神经内镜、颅底骨缺损、经鼻蝶手术入路、多重修补、带蒂黏膜瓣、聚醚醚酮、羟基磷灰石”,英文检索词为“Skull base reconstruction,Neuroendoscopy,Skull base bone defect,Transnasal-sphenoidal operative approach,Multiple repair,Pedicled mucosal flap,Polyether-ether-ketone(PEEK),Hydroxylapatite”,最终纳入60篇文献进行综述。结果与结论:(1)神经内镜经鼻蝶术后,即使颅底缺损越来越大,颅底重建的目地依旧是预防脑脊液漏避免严重并发症,目前多层修补是一致认可的修复原则。(2)骨性支撑的类骨材料诸如聚醚醚酮、羟基磷灰石因为价格昂贵且术前准备繁琐,临床应用较少;临床医生多靠类硬膜结构的生物材料及带蒂黏膜瓣完成修补,但受限于修补支撑力弱及黏膜瓣血运情况,少数病患仍有一定概率存在脑脊液漏的风险。(3)因此,术中类硬膜、类骨结构人工生物材料以及带蒂黏膜瓣修补颅底缺损符合恢复颅底的解剖修复,有助于硬膜、骨质结构的再生,这样也使疏水组织-类硬膜结构-类骨结构-黏膜的一体化生物材料研发具有广阔的应用前景。
