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Skull defect is a common clinical disease, and the corresponding treatment is still a grand challenge. No artificial product can perfectly integrate with human skull and match the skull defect during growth. Herein, we report a porous polyetheretherketone (PEEK) implant with the microstructures almost identical to natural bones for repairing skull defect. Compared to non-porous PEEK controls, the porous PEEK implants efficiently promote cell adhesion, regenerate skull tissues, and finally achieve perfect healing with surrounding tissues within 6 months. This work suggests the important potential of integrated porous PEEK implants for treating skull defect in clinic, especially for children with rapidly growing skulls.

Objective: Graft failure is a common complication of cranioplasty. Revision cranioplasty is required to overcome this complication. However, no previous studies have reported outcomes in revision cranioplasty with 3-dimensional (3D) custom-made titanium implants. We describe our experience with 3D titanium implants in patients with revision cranioplasty., Methods: We evaluated 43 consecutive patients between January 2011 and December 2019 who underwent revision cranioplasty using 3D custom-made titanium implants. The 3D image of the patient's cranium and the plan to close the cranium defect were created in a virtual environment using software programs. Demographic and radiologic features were compared based on the materials used in the initial cranioplasty., Results: Previous material was autologous graft (AG) in 27 patients and polymethyl methacrylate (PMMA) in 16 patients. The mean time without revision cranioplasty is longer in patients with PMMA implants than in patients with AG. There was no statistically significant difference in the length of hospital stay between patients with PMMA implants and patients with AG. There were no postoperative adverse events such as infection, wound dehiscence, convulsions, or epidural hematoma in 38 patients during hospitalization. Wound dehiscence developed in 5 patients and surgical repair was required in one., Conclusions: Initial cranioplasty with PMMA provides a longer time period than the AG before the revision. However, both of them have similar outcomes based on length of hospital stay and cranial defect area. Custom-made 3D titanium implant is a good option for revision cranioplasty to prevent implant failure and reduce patients' cosmetic concerns., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Syndrome of the trephined, or sinking skin flap syndrome, is a rare complication following craniectomy, showing a variety of neurological symptoms that improve after cranioplasty. Taste disorders can be induced by a variety of causes, while those due to central lesions are rare. We report a case of syndrome of the trephined that developed a taste disorder as a sole manifestation. A 61-year-old man underwent enlarged left craniectomy due to bacterial infection after surgical resection of a convexity meningioma. In six weeks, the patient complained of taste abnormalities. Visual analog scale score, electrogustometry, and a whole-mouth gustatory test revealed impairment of taste perception. As other possible causative factors were excluded, and the symptom improved after the cranioplasty, we made the diagnosis of syndrome of the trephined. Gustatory information from one side of the tongue enters the nucleus of the solitary tract of the medulla, and reaches insular-operculum ipsilaterally through the ventroposterior medial nucleus of the thalamus. Additionally, it is speculated that gustatory information from the left side of the tongue directly reaches the left insula, while information from the right side may also reach the left insula through the right insula. Disturbance of the left hemisphere including the insula due to a skull defect may have caused impairment of taste perception. A taste disorder should bear in mind in the treatment of central nervous system diseases and taken into account as a manifestation of syndrome of the trephined.

Apigenin, a natural compound in celery, is found to have pro-osteogenesis capacity by screening in our previous work. This study is focused on its pro-osteogenesis mechanism evaluation. The pro-osteogenesis effect of apigenin (50 mg/kg/day), was evaluated in skull defected (SD) mice by monitoring changes in bone histomorphometry index, formation of new osteoblasts from MSCs and changes in the synthesis of pro-osteogenic cytokines. Signal pathways were investigated by QPCR, Western blot and immunofluorescence. Apigenin has significant pro-osteogenesis effect in vivo, which can promote osteoblasts formation, the expression of osteoblasts-specific marker genes and osteoblasts marker protein in vitro. From the perspective of molecular biology, apigenin promotes osteoblasts formation and the activation of Wnt pathway as well as the induction and nuclei translocation of β-catenin. Driven by the results of this study, celery might be a useful alternative functional food in helping bone defects regeneration.

Background: Pasteurella multocida is a gram-negative coccobacillus that is primarily found in oropharynx of dogs, cats and other animals. It causes infections in human beings through contact with animal saliva in the form of licks, bites and scratches of animals colonized by the bacteria. Meningitis due to Pasteurella multocida is rare in immunocompetent individuals. We report a case of meningitis due to Pasteurella multocida in an immunocompetent patient. Case report: A 30-year-old gentleman presented with 2-day history of fever and neck stiffness. 6 weeks earlier, he was treated as a case of bacterial meningitis. During that hospital stay, he was diagnosed to have bony defect in the sellar floor based on MRI head performed to evaluate for a prolonged history of CSF rhinorrhea. He was discharged and scheduled for an elective endoscopic endonasal/open repair of the skull base defect after resolution of meningitis. CSF findings during current admission also showed features of bacterial meningitis. CSF culture showed Pasteurella multocida sensitive to penicillin, ampicillin and ceftriaxone. Retrospective history revealed patient’s contact with stray cats as he used to feed them but there was no history of licks, bites. He was treated with intravenous ceftriaxone 2 g twice a day for 14 days with complete resolution of his symptoms. Conclusion: Pasteurella multocida is an important cause of bacterial meningitis in patients with skull defect. Patients with traumatic or non-traumatic bony defect of skull should avoid contact with dogs and cats to prevent the spread of infection the central nervous system.

The authors report a case of a patient managed for severe cranial vault depression following combined neurosurgery and radiotherapy. This situation caused major aesthetic discomfort and was potentially dangerous due to the mechanical weakness of the bone flap. The authors had a CAD (computer aided design) silicone elastomer custom-made implant made to fill perfectly the depression. Beforehand, an expansion was performed to cover the implant after removal of the radiated skin. The surgery and post-operative course raised no concerns. After one year of follow-up, the result is very good and the patient very satisfied, proving that this technique certainly has its place in the therapeutic arsenal when faced with a tissue defect of the cranial vault., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: In our technical note, we have presented a technique of cranioplasty for large skull defects., Methods: A thin-slice computed tomography scan is performed. A model of the skull is constructed using a desktop 3-dimensional printer from the computed tomography scan. The skull model is filled with towels of soft cotton and inserted in a sterile thin plastic bag. The implant is molded intraoperatively on the skull model under sterile conditions. After surgical exposure of the skull defect, the implant is inserted and fixed using miniplates and miniscrews. The technique was used in 6 patients and described in 2 representative cases., Results: The required time and cost are significantly lower than those for other techniques used for preoperative manufacture of implants. No technique-related complications occurred. The radiological and cosmetic results were satisfactory. In the present case series, no early or delayed complications occurred., Conclusion: The presented technique is simple, safe, and time- and cost-effective. The technique and results are reproducible., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To clarify the clinical outcomes of cranioplasty with cryopreserved bone flaps and identify risk factors related to bone flap infection and resorption after cranioplasty with cryopreserved bone flaps., Methods: A total of 946 patients (989 bone flaps) underwent decompressive craniectomy and delayed cranioplasty via the use of cryopreserved autogenous cranial bone flaps. Cranial bone flaps were removed during the initial craniectomy and reserved in liquid nitrogen (-196°C) with dimethyl sulfoxide as a cryoprotectant. Cranioplasty subsequently was performed once the brain injury had healed. Data regarding complications and clinical outcomes were recorded and the potential risk factors were analyzed., Results: Data from 960 flaps were available for analysis. The overall complication rate was 15.83% (152 of 960). Bone resorption occurred in 42 flaps in 37 patients (4.38%). The bone flaps resorption rate was greater in patients ≤18 years than in patients >18 years (9.38% vs. 3.61%, P < 0.05). Cryopreservation for more than 365 days tended to result in a greater bone resorption rate (6.88% vs. 2.92%, P < 0.01). Skull bone grafts infection occurred in 39 flaps in 34 patients (4.06%). The bone graft infection rate was greater in emergency craniectomy cases (8.81% vs. 2.59%, P < 0.01) and in patients with diabetes (10.53% vs. 3.07%, P < 0.01)., Conclusions: Cryopreservation of autologous cranial bone flaps is safe and effective for cranioplasty. Cranioplasty with cryopreserved autologous cranial bone flaps should be performed no more than 1 year after craniectomy. Emergency craniectomy and patients with diabetes require special attention., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Cranioplasty using custom-made hydroxyapatite (HAP) ceramic implants is a common procedure to repair skull defects. However, commercially available titanium screws are only minimally stabilized due to characteristic brittleness. We developed the RIVET technique which involves fixing a bioabsorbable plate atop a HAP block using bioabsorbable screws extending beyond both layers, and evaluated fixation strength using the pull-out test and microtomography. Three experimental conditions were compared: a non-RIVET group, RIVET group, and dry skull control group. Pull-out strength significantly differed across groups (non-RIVET group, 1.33 ± 1.21 kgf; RIVET group, 4.46 ± 0.84 kgf; and control group, 6.99 ± 1.14 kgf, P < 0.01). Microtomography of the dry skull control group revealed thread grooves fitted to the screws. The non-RIVET and RIVET groups presented fewer thread grooves than the control group, and the screws did not fit perfectly to the HAP block. However, fixation in the RIVET group was more stable, as the rivet was firmly lodged into the implant. In conclusion, by melting and creating the rivet, pull-out strength can be increased and rigid stabilization of HAP can be obtained. This technique uses commercially available absorbable plate and screws, and thus can be used widely in clinical applications involving HAP blocks with different porosities and thicknesses., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)