TRACTION METHOD FOR REPAIRING DAMAGED TITANIUM CRANIOPLASTIC IMPLANTS
The development of neurosurgery, neuroresuscitation intensive care, made it possible to reduce mortality in severe craniocerebral trauma, brain tumors, but did not reduce the number of patients with post-cranioectomy defects. The incidence of cranioplasty is 12.9 per 100,000 population per year. Most often (up to 95% of cases), cranioplasty with titanium mesh implants is used. A significant proportion of patients have long-term neurocognitive and neurobehavioral consequences, which often lead to repeated trauma. To our knowledge, there have been no reports of closed repair of damaged implants. Methods. Deformation of the titanium plate due to trauma occurred in 5 patients, during the period from 2012 to 2019 at the First City Clinical Hospital of Arkhangelsk. A traction straightener was developed that allows the depressed part of the implant to be pulled out percutaneously. Results. Restoration of the shape and volume of the cranial vault is important for the medical and social rehabilitation of patients. The use of the traction method allows the implant to be repaired without additional incisions and discomfort for the patient in case of repeated trauma, while avoiding infectious and other surgical complications typical of open interventions to replace the implant. Discussion. Exposure to high mechanical forces can deform the implant. Mechanical impact most often does not lead to other complications, except for the deformation of the titanium plate. Usually, if the implant is damaged, it is replaced, but this is a technically difficult operation due to the growth of scar and bone tissue into each hole of the plate. Our method avoids the need for major surgical intervention and implant replacement. Our experience has shown no negative aspects of this method. Conclusion. Titanium cranioplasty protects the brain tissue in patients with skull defects, but mechanical force can lead to a deformation of the implant. Our titanium implant repair technique helps to eliminate the defect in a short amount of time, under local anesthesia.