04 July 2018

Metalheads found to fare better post surgery

Patients requiring the removal of a portion of their skull to alleviate pressure from a swelling brain have been found to recover better if their skull is repaired using a titanium plate rather than their original piece of bone (which is kept refrigerated until the swelling subsides).

A study led by researchers from Royal Perth Hospital has found that those whose skulls were rebuilt using the original portion of bone, known as “bone flap” were more likely to experience complications such as infection and bone resorption (where the bone disintegrates and is absorbed into the body). When this occurs further surgery is needed to rebuild the skull to protect the underlying brain.

The findings of the study, which was funded using a State Government Research Translation Project grant, are detailed in a recent edition of the medical journal European Journal of Neurosurgery.

Skull reconstruction following brain swelling – known as cranioplasty – is often performed on patients who have brain swelling due to a stroke or traumatic brain injury (such as a one-punch attack).

The removal of a piece of skull alleviates pressure caused by the swelling. Such pressure can restrict the flow of blood and oxygen to the brain. Once the swelling subsides the skull can be repaired.

The recent study compared the effectiveness, and long-terms costs, of two materials commonly used to restore the skull – the patient’s own bone flap or a customised titanium plate.

The trial, which ran for about two and a half years between 2012 and 2015, randomised 64 patients to one of the two reconstruction options. It found that those assigned to the titanium arm had slightly better outcomes in the 12 months post reconstruction than the bone-flap cohort.

However that difference increased as time went on.

“The reason for this was that bone resorption continued beyond 12 months and some patients required further surgery using titanium,” RPH biomedical engineer and one of the study’s authors, Dr David Morrison, explained.

“Traditionally, the patient’s own bone was preferred because it was cheap, strong, biocompatible and fit the skull defect perfectly.

“While titanium shared many of these benefits and its shape can be customised to fit the patient’s skull defect, it is more expensive to produce.”

The study was designed to see if, taking into account the costs of complications and repeat surgery, titanium was still the more expensive option over the long-term.

The study concluded that the use of titanium at the time of reconstruction reduced the likelihood of the patient needing further surgery and this also reduced the associated long-term hospital costs.

The study was led by fellow RPH employee Consultant neurosurgeon, Dr Stephen Honeybul. Other contributors were RPH Intensive Care Unit consultant, Dr Kwok Ming Ho, consultant neurosurgeon Christopher Lind and Dr Elizabeth Geelhoed from the University of WA’s School of Population Health.


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