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Cell-Augmented Scaffold-Enhanced (CASE) Cranioplasty: A New Regenerative Paradigm for Interval Autologous Cranioplasty
M. Grace Knudsen, MD
Devin Barzallo, BA
Tiffany Hodges, MD
Brian Rothstein, MD
Edward H. Davidson, MD
University Hospitals Cleveland Medical Center
2022-01-15
Presenter: M. Grace Knudsen, MD
Affidavit:
Resident was responsible for data collection, data analysis and abstract preparation.
Director Name: Edward Davidson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Objective: Autologous interval cranioplasty is the standard of care following decompressive craniectomy. Replantation of stored bone has infection and bone resorption rates upwards of 30%. We propose a new paradigm for autologous cranioplasty incorporating novel regenerative techniques that aims to improve fidelity of grafts and reduce infection and resorption.
Methods: 12 CASE cranioplasty patients was compared to 13 "traditional" patients. Cell-augmentation of autologous bone graft differed from traditional methods: channels created in the diploic space were packed with a 1:1 mixture of freshly harvested autologous bone graft and bone allograft. Primary outcome measures included post-operative graft infection, bone resorption after >6 months and graft explantation. Additional datapoints include demographic and surgical details. Student's independent t-test and 2 analysis with p = 0.05 set as significant. Descriptive statistics include risk differences (RD), means and standard deviations (SD).
Results: Clinical evaluation after ≥ 6 months demonstrated a bone graft infection rate of 0%, resorption rate of 0% and explantation rate of 0% for CASE subjects and 15.4% (n=2), 0% and 15.4% for traditional patients, respectively; RD for post-operative infection and explantation was 15.4%. Mean age at cranioplasty was 43.7 years (SDą20.0) for CASE subjects vs 57.5 years (SDą12.9) for traditional (p=0.05). Mean duration of surgery was 219.25min (SDą50.7min) for CASE subjects vs 113.5 (SDą50.5min) for traditional (p<0.001). All other variables were not significantly different.
Conclusions: Cell-Augmented Scaffold-Enhanced cranioplasty represents a safe novel paradigm modification to standard autologous interval cranioplasty technique with reduced rates of post-operative infection, bone flap resorption and reoperation.
