Journal article
The Adjustable Cranial Plate (ACP): A novel implant designed to eliminate the need for cranioplasty surgery following a hemicraniectomy operation
World neurosurgery, Vol.173, pp.e306-e320
05/2023
DOI: 10.1016/j.wneu.2023.02.045
PMID: 36804433
Abstract
Decompressive hemicraniectomy (DHC) is performed to relieve life-threatening intracranial pressure elevations. After swelling abates, a cranioplasty is performed for mechanical integrity and cosmesis. Cranioplasty is costly with high complication rates. Prior attempts to obviate second stage cranioplasty have been unsuccessful. The Adjustable Cranial Plate (ACP) is designed for implantation during DHC to afford maximal volumetric expansion with later repositioning without requiring a second major operation.
The ACP has a mobile section held by a tripod fixation mechanism. Centrally located gears adjust the implant between the UP and DOWN positions. Cadaveric ACP implantation was performed. Virtual DHC and ACP placement was done using imaging data from 94 patients who had previously undergone a DHC procedure to corroborate our cadaveric results. Imaging analysis methods were used to calculate volumes of cranial expansion.
The ACP implantation and adjustment procedures are feasible in cadaveric testing without wound closure difficulties. The results of the cadaveric study showed total volumetric expansion achieved was 222cm3. Results of the virtual DHC procedure show the volume of cranial expansion achieved by removing a standardized bone flap is 132cm3 (range 89-171cm3). Applied to virtual craniectomy patients, the total volume of expansion achieved with the ACP implantation operation was 222cm3 (range 181-263cm3).
ACP implantation during DHC procedure is technically feasible. It achieves a volume of cranial expansion that will accommodate that observed following survivable HC operations. Moving the implant from the UP to the DOWN position can easily be performed as a simple outpatient or in-patient bedside procedure, thus potentially eliminating second-stage cranioplasty procedures.
Details
- Title: Subtitle
- The Adjustable Cranial Plate (ACP): A novel implant designed to eliminate the need for cranioplasty surgery following a hemicraniectomy operation
- Creators
- David ChristiansonScott C. SeamanEmanuel RayLuyuan LiMario ZanatyPat LemoineGrant WilsonDaniel GrimmBrian J. ParkColin GoldBrian AndrewsSean GradyKathleen DlouhyMatthew A. Howard
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.173, pp.e306-e320
- DOI
- 10.1016/j.wneu.2023.02.045
- PMID
- 36804433
- NLM abbreviation
- World Neurosurg
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Publisher
- Elsevier Inc
- Language
- English
- Electronic publication date
- 02/15/2023
- Date published
- 05/2023
- Academic Unit
- Neurology; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Craniofacial Anomalies Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9984368302802771
Metrics
10 Record Views