Cranioplastias e correção de rinoliquorréias com metilmetacrilato: considerações a propósito de 35 casos

Pereira, Walter C.; Tenuto, Rolando A.; Vellutini, Darcy F.

doi:10.1590/S0004-282X1965000300002

Resumos

São passados em revista os principais tipos de tratamento empregados para a correção das falhas ósseas cranianas, sendo discutidas algumas de suas vantagens e desvantagens. Os resultados obtidos com o uso do metil-metacrilato em cranioplastias são, na opinião de muitos autores, bastante satisfatórios, raramente sendo registradas complicações. É apresentada a experiência com o metilmetacrilato em 35 pacientes portadores de defeitos ósseos cranianos: 32 cranioplastias, duas correções de rinoliquorréias e um caso em que, simultâneamente, foram feitas cranio-plastia e tamponamento de fístula. O seguimento dos doentes foi de 4 anos em apenas um caso; em outros dez variou de um a três anos e nos demais casos foi inferior a um ano. Em 4 casos houve supuração local, tornando-se necessário remover a prótese para que o processo supurativo fôsse controlado. Houve um caso de óbito dois meses após a cranioplastia, em conseqüência de abscesso cerebral. Em 26 cranioplastias os resultados estéticos foram satisfatórios, havendo apenas em um caso deslocamento da prótese. Nos três casos de rinoliquorréias houve desaparecimento da perda de líquido cefalorraqueano após as intervenções cirúrgicas com a resina acrílica. Em 29 cranioplastias o metilmetacrilato foi aplicado diretamente sôbre as falhas ósseas, sem proteção alguma dos tecidos subjacentes; em nenhum caso surgiram indícios de que êste processo fôsse lesivo para o tecido nervoso. Nas três cranioplastias restantes empregou-se a técnica de Spence, na qual a resina é modelada dentro de um saco de polietileno, só entrando em contato com os tecidos depois da polimerização. Nas rinoliquorréias, antes do tamporamento das falhas ósseas com o metilmetacrilato, foram cuidadosamente reparadas as lesões da dura-máter.

The principal methods in the treatment of cranial bony defects are briefly reviewed and some advantages and disadvantages of them are discussed. According to several authors the results obtained with the use of methymethacrylate in cranioplasties are very satisfactory, the complications being unusual. The experience of the authors in 35 cases of skull defects treated with methylmethacrylate is presented: 32 cranioplasties, two corrections of cerebrospinal fluid rhinorrhea and one case in which cranioplasty and blockage of a cranionasal fistula was simultaneously made. The longest follow-up was of four years in only one case; in ten cases it was from one to three years and in the others the pursuing was less than a year. In four cases there was local suppuration, the remotion of the acrylic plate becoming necessary in three of them; in one case the plate was not removed, and the infection still remains. One patient died two months after the cranioplasty in consequence to a brain abscess. In 26 cranioplasties the cosmetic results were satisfactory; only in one case there was a slight displacement of the prothesis. In the three patients with rhinorrhea the drainage of cerebrospinal fluid ceased completely after surgery. In 29 cranioplasties the methylmethacrylate was applied directly into the skull defect without protection of the encephalic tissue; there were no signs of damage of the nervous system in any case. Only in three cranioplasties the Spence's technique was used; in this technique the acrylic resin is molded within a polyethylene bag, thus being put in place after polymerization. In the cases of cerebrospinal fluid rhinorrhea the dural injuries were carefully repaired before the blockage of the bony defects with methylmethacrylate.

Walter C. Pereira^I; Rolando A. Tenuto^II; Darcy F. Vellutini^I

^INeuro-cirurgiões; Trabalho da Clínica Neurológica da Faculdade de Medicina da Universidade de São Paulo (Prof. Adherbal Tolosa), apresentado ao XI Congresso Latino-Americano de Neurocirurgia (11 a 15 de agôsto de 1965, São Paulo, Brasil)

^IINeurocirurgião-Chefe; Trabalho da Clínica Neurológica da Faculdade de Medicina da Universidade de São Paulo (Prof. Adherbal Tolosa), apresentado ao XI Congresso Latino-Americano de Neurocirurgia (11 a 15 de agôsto de 1965, São Paulo, Brasil)

RESUMO

São passados em revista os principais tipos de tratamento empregados para a correção das falhas ósseas cranianas, sendo discutidas algumas de suas vantagens e desvantagens. Os resultados obtidos com o uso do metil-metacrilato em cranioplastias são, na opinião de muitos autores, bastante satisfatórios, raramente sendo registradas complicações.

É apresentada a experiência com o metilmetacrilato em 35 pacientes portadores de defeitos ósseos cranianos: 32 cranioplastias, duas correções de rinoliquorréias e um caso em que, simultâneamente, foram feitas cranio-plastia e tamponamento de fístula. O seguimento dos doentes foi de 4 anos em apenas um caso; em outros dez variou de um a três anos e nos demais casos foi inferior a um ano.

Em 4 casos houve supuração local, tornando-se necessário remover a prótese para que o processo supurativo fôsse controlado. Houve um caso de óbito dois meses após a cranioplastia, em conseqüência de abscesso cerebral. Em 26 cranioplastias os resultados estéticos foram satisfatórios, havendo apenas em um caso deslocamento da prótese. Nos três casos de rinoliquorréias houve desaparecimento da perda de líquido cefalorraqueano após as intervenções cirúrgicas com a resina acrílica.

Em 29 cranioplastias o metilmetacrilato foi aplicado diretamente sôbre as falhas ósseas, sem proteção alguma dos tecidos subjacentes; em nenhum caso surgiram indícios de que êste processo fôsse lesivo para o tecido nervoso. Nas três cranioplastias restantes empregou-se a técnica de Spence, na qual a resina é modelada dentro de um saco de polietileno, só entrando em contato com os tecidos depois da polimerização. Nas rinoliquorréias, antes do tamporamento das falhas ósseas com o metilmetacrilato, foram cuidadosamente reparadas as lesões da dura-máter.

ABSTRACT

The principal methods in the treatment of cranial bony defects are briefly reviewed and some advantages and disadvantages of them are discussed. According to several authors the results obtained with the use of methymethacrylate in cranioplasties are very satisfactory, the complications being unusual.

The experience of the authors in 35 cases of skull defects treated with methylmethacrylate is presented: 32 cranioplasties, two corrections of cerebrospinal fluid rhinorrhea and one case in which cranioplasty and blockage of a cranionasal fistula was simultaneously made. The longest follow-up was of four years in only one case; in ten cases it was from one to three years and in the others the pursuing was less than a year.

In four cases there was local suppuration, the remotion of the acrylic plate becoming necessary in three of them; in one case the plate was not removed, and the infection still remains. One patient died two months after the cranioplasty in consequence to a brain abscess. In 26 cranioplasties the cosmetic results were satisfactory; only in one case there was a slight displacement of the prothesis. In the three patients with rhinorrhea the drainage of cerebrospinal fluid ceased completely after surgery.

In 29 cranioplasties the methylmethacrylate was applied directly into the skull defect without protection of the encephalic tissue; there were no signs of damage of the nervous system in any case. Only in three cranioplasties the Spence's technique was used; in this technique the acrylic resin is molded within a polyethylene bag, thus being put in place after polymerization. In the cases of cerebrospinal fluid rhinorrhea the dural injuries were carefully repaired before the blockage of the bony defects with methylmethacrylate.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

1. ABBOTT, K. H. - Use of frozen cranial flaps for autogenous and homogenous grafts in cranioplasty and spinal interbody fusion. J. Neurosurg. 10:380-388, 1953.
2. CALNAN, J. - The use of plastic material in reconstructive surgery: I) A biological test for tissue acceptance; II) Tissue reactions to commonly used materials. Brit. J. plast. Surg. 16:1-22, 1963.
3. DODGE, H. W. & CRAIG, W. M. - Acrylic cranioplasty: a newer rapid method for the repair of cranial defects; preliminary report. Proc. Mayo Clin. 28:256-257, 1953.
4. FULCHER, O. H. - Tantalum as a metalic implant to repair cranial defects. J. Amer. med. Ass. 121: 931-933, 1943.
5. GRANT, F. C. & NORCROSS, N. C. - Repair of cranial defects by cranioplasty. Ann Surg. 110:488-512, 1939.
6. GURDJIAN, E. S.; WEBSTER, J. E. & BROWN, J. C. - Impression technique for reconstruction of large skull defects. Surgery, 14:876-881, 1943.
7. JACKSON, I. J. & HOFFMANN, G. T. - Depressed comminuted fracture of a plastic cranioplasty. J. Neurosurg. 13:116-117, 1956.
8. JAKOBY, R. K. - The use of methylmethacrylate seal in spinal fluid otorrhea and rhinorrhea. J. Neurosurg. 18-614-615, 1961.
9. KENNETH LEWIS, G. - Bony defects of the head repaired with cancelous bone. Amer. J. Surg. 85:83-90, 1953.
10. KIEHN, C. L. & GRINO, A. - Iliac bone grafts replacing tantalum for gunshot wounds of the skull. Amer. J. Surg. 85:395-400, 1953.
11. LANE, E. S. & WEBSTER, J. E. - A report of the early results in tantalum cranioplasty. J. Neurosurg. 4:526-529, 1947.
12. LEITHOLF, O. - Anwendung von Kunststoffen in der Neurochirurgie. Münch, med. Wschr. 105:1771-1773, 1963.
13. LONGACRE, J. J. - Surgical correction of extensive defects of scalp and cranium with autogenous tissues. In Transactions of the International Society of Plastic Surgens. First Congress. Willians & Wilkims Co., Baltimore, 1957, pp. 346-358.
14. MARVIN, S. A. - Plastics in plastic surgery: a review of the carcinogenic problem. Tex. Rep. Biol. Med. 21:163-167, 1963.
15. McCLINTOCK, H. G. & DING-MAN, R. O. - The repair of cranial defects with iliac bone. Surgery, 30:955-962, 1951.
16. NOON, C. - Repair of large bony defects in the skull by means of a metal plate. With a record of three cases. Lancet, 1:373-374, 1917.
17. OLIVER, L. C. & BLAINE, G. - A new one-stage method of cranioplasty with acrylic plastic. Med Press. 220:167-169, 1948.
18. OPPENHEIMER, B. S.; OPPENHEIMER, E. T. & STOUT, A. P. - Sarcomas induced in rats by implanting cellophane. Proc. Soc. exp. Biol. 67:33-34, 1948.
19. OPPENHEIMER, B. S.; OPPENHEIMER, E. T. & STOUT, A. P. - Sarcomas induced in rodents by imbedding various plastic films. Proc. Soc. exp. Biol. 79:366-369, 1952.
20. OPPENHEIMER, B. S.; OPPENHEIMER, E. T. & STOUT, A. P. - Carcinogenic effect of imbedding various plastic films in rats and mice. Surg. Forum, 4:672-676, 1953.
21. OPPENHEIMER, B. S.; OPPENHEIMER, E. T.; DANISHEFSKY, I.; STOUT, A. P. & EIRICH, F. R. - Further studies of polymers as carcinogenic agents in animals. Cancer Res. 15:333-340, 1955.
22. OPPENHEIMER, B. S.; OPPENHEIMER, E. T.; STOUT, A. P.; WILLHITE, M. & DANISHEFSKY, I. - The latent period in carcinogenesis by plastics in rats and its relation to the pressarcomatous stage. Cancer, 11:204-213, 1958.
23. PUDENZ, R. H. - The repair of cranial defects with tantalum. An experimental study. J. Amer. med. Ass. 121:478-481, 1943.
24. RIETZ, K. - The one-stage method of cranioplasty with acrylic plastic. With a follow-up study. J. Neurosurg. 15:176-182, 1958.
25. ROSS, P. J. & JELSMA, T. - Experiences with acrylic plastic for cranioplasties. Amer. Surg. 26:519-524, 1960.
26. SCOTT, M. & WYCIS, H. T. - Experimental observations on the use of stainless steel for cranioplasty. A comparison with tantalum. J. Neurosurg. 3:310-317, 1946.
27. SMALL, J. M. & GRAHAM, M. P. - Acrylic resin for closure of skull defects. Preliminary reports. Brit. J. Surg. 32:106-113, 1944-1945.
28. SPENCE, W. T. - Form.-fitting plastic cranioplasty. J. Neurosurg. 11:219-225, 1954.
29. SPENCE, W. T. - Ten years experience using form-fitting plastic for cranioplasty. Bull. Georgetown Univ. med. Cent. 10:154-160, 1957.
30. STRELI, R. - The use of deep-frozen cranial-bone homografts in the repair of defects of the skull. Brit. J. plast. Surg. 12:200-207, 1959.
31. TENUTO, R. A. & ZACLIS, J. - Cranioplastia com tântalo. Arq. Neuro-Psiquiat. 5:53-58, 1947.
32. THOMAS, L. M.; WEBSTER, J. E. & GUDJIAN, E. S. - A note on the use of methylmethacrylate for sealing the bony portion of a cranionasal fistula. J. Neurosurg. 17:355-356, 1960.
33. TROTOT, R. P. & COR-BEIL, R. - Réparation des brèches craniennes à l'aide de plaques de résine acry-lique. Presentation de malades. Rev. neurol. 79:426-427, 1947.
34. URIST, M. R. & McLEAN, F. C. - The local phisiology of bone repair. With particular reference to the process of new bone formation by induction. Amer. J. Surg. 85:444-449, 1953.
35. WEIFORD, E. C. & GARDNER, W. J. - Tantalum cranioplasty. Review of 116 cases in civilian practice. J. Neurosurg. 6:13-32, 1949.
36. WLAHO-VITCH, B. & GARREL, A. - La prothèse dans les cranioplasties. Montpellier méd. 53(2):292-304, 1958.
37. WOLFF, J. I. & WALKER, A. E. - Cranioplasty. Coletive review. Int. Abstr. Surg. 81:1-23, 1945.
38. WORINGER, E.; SCHWIEG, G. & SCHNEIDER, J. - Nouvelle technique ultra-rapide pour la réfection de brèches osseuses craniennes ã la résine acrylique. Avantages de la resine acrylique sur le tantale. Rev. neurol. 85:527-535, 1951.
39. WORINGER, E. - Nouvelle technique ultra-rapide pour la fermeture de brèches craniennes avec une résine acrylique autopolymérizable. Acta chir. belg. 51:655-659, 1952.

Cranioplastias e correção de rinoliquorréias com metilmetacrilato. Considerações a propósito de 35 casos

Cranioplasties and repair of cerebrospinal fluid rhinorrhea with methylme-thacrylate. Comments on 35 cases

Datas de Publicação

Publicação nesta coleção
15 Ago 2013
Data do Fascículo
Set 1965

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ABBOTT, K. H. - Use of frozen cranial flaps for autogenous and homogenous grafts in cranioplasty and spinal interbody fusion. J. Neurosurg. 10:380-388, 1953.

[2] 2. CALNAN, J. - The use of plastic material in reconstructive surgery: I) A biological test for tissue acceptance; II) Tissue reactions to commonly used materials. Brit. J. plast. Surg. 16:1-22, 1963.

[3] 3. DODGE, H. W. & CRAIG, W. M. - Acrylic cranioplasty: a newer rapid method for the repair of cranial defects; preliminary report. Proc. Mayo Clin. 28:256-257, 1953.

[4] 4. FULCHER, O. H. - Tantalum as a metalic implant to repair cranial defects. J. Amer. med. Ass. 121: 931-933, 1943.

[5] 5. GRANT, F. C. & NORCROSS, N. C. - Repair of cranial defects by cranioplasty. Ann Surg. 110:488-512, 1939.

[6] 6. GURDJIAN, E. S.; WEBSTER, J. E. & BROWN, J. C. - Impression technique for reconstruction of large skull defects. Surgery, 14:876-881, 1943.

[7] 7. JACKSON, I. J. & HOFFMANN, G. T. - Depressed comminuted fracture of a plastic cranioplasty. J. Neurosurg. 13:116-117, 1956.

[8] 8. JAKOBY, R. K. - The use of methylmethacrylate seal in spinal fluid otorrhea and rhinorrhea. J. Neurosurg. 18-614-615, 1961.

[9] 9. KENNETH LEWIS, G. - Bony defects of the head repaired with cancelous bone. Amer. J. Surg. 85:83-90, 1953.

[10] 10. KIEHN, C. L. & GRINO, A. - Iliac bone grafts replacing tantalum for gunshot wounds of the skull. Amer. J. Surg. 85:395-400, 1953.

[11] 11. LANE, E. S. & WEBSTER, J. E. - A report of the early results in tantalum cranioplasty. J. Neurosurg. 4:526-529, 1947.

[12] 12. LEITHOLF, O. - Anwendung von Kunststoffen in der Neurochirurgie. Münch, med. Wschr. 105:1771-1773, 1963.

[13] 13. LONGACRE, J. J. - Surgical correction of extensive defects of scalp and cranium with autogenous tissues. In Transactions of the International Society of Plastic Surgens. First Congress. Willians & Wilkims Co., Baltimore, 1957, pp. 346-358.

[14] 14. MARVIN, S. A. - Plastics in plastic surgery: a review of the carcinogenic problem. Tex. Rep. Biol. Med. 21:163-167, 1963.

[15] 15. McCLINTOCK, H. G. & DING-MAN, R. O. - The repair of cranial defects with iliac bone. Surgery, 30:955-962, 1951.

[16] 16. NOON, C. - Repair of large bony defects in the skull by means of a metal plate. With a record of three cases. Lancet, 1:373-374, 1917.

[17] 17. OLIVER, L. C. & BLAINE, G. - A new one-stage method of cranioplasty with acrylic plastic. Med Press. 220:167-169, 1948.

[18] 18. OPPENHEIMER, B. S.; OPPENHEIMER, E. T. & STOUT, A. P. - Sarcomas induced in rats by implanting cellophane. Proc. Soc. exp. Biol. 67:33-34, 1948.

[19] 19. OPPENHEIMER, B. S.; OPPENHEIMER, E. T. & STOUT, A. P. - Sarcomas induced in rodents by imbedding various plastic films. Proc. Soc. exp. Biol. 79:366-369, 1952.

[20] 20. OPPENHEIMER, B. S.; OPPENHEIMER, E. T. & STOUT, A. P. - Carcinogenic effect of imbedding various plastic films in rats and mice. Surg. Forum, 4:672-676, 1953.

[21] 21. OPPENHEIMER, B. S.; OPPENHEIMER, E. T.; DANISHEFSKY, I.; STOUT, A. P. & EIRICH, F. R. - Further studies of polymers as carcinogenic agents in animals. Cancer Res. 15:333-340, 1955.

[22] 22. OPPENHEIMER, B. S.; OPPENHEIMER, E. T.; STOUT, A. P.; WILLHITE, M. & DANISHEFSKY, I. - The latent period in carcinogenesis by plastics in rats and its relation to the pressarcomatous stage. Cancer, 11:204-213, 1958.

[23] 23. PUDENZ, R. H. - The repair of cranial defects with tantalum. An experimental study. J. Amer. med. Ass. 121:478-481, 1943.

[24] 24. RIETZ, K. - The one-stage method of cranioplasty with acrylic plastic. With a follow-up study. J. Neurosurg. 15:176-182, 1958.

[25] 25. ROSS, P. J. & JELSMA, T. - Experiences with acrylic plastic for cranioplasties. Amer. Surg. 26:519-524, 1960.

[26] 26. SCOTT, M. & WYCIS, H. T. - Experimental observations on the use of stainless steel for cranioplasty. A comparison with tantalum. J. Neurosurg. 3:310-317, 1946.

[27] 27. SMALL, J. M. & GRAHAM, M. P. - Acrylic resin for closure of skull defects. Preliminary reports. Brit. J. Surg. 32:106-113, 1944-1945.

[28] 28. SPENCE, W. T. - Form.-fitting plastic cranioplasty. J. Neurosurg. 11:219-225, 1954.

[29] 29. SPENCE, W. T. - Ten years experience using form-fitting plastic for cranioplasty. Bull. Georgetown Univ. med. Cent. 10:154-160, 1957.

[30] 30. STRELI, R. - The use of deep-frozen cranial-bone homografts in the repair of defects of the skull. Brit. J. plast. Surg. 12:200-207, 1959.

[31] 31. TENUTO, R. A. & ZACLIS, J. - Cranioplastia com tântalo. Arq. Neuro-Psiquiat. 5:53-58, 1947.

[32] 32. THOMAS, L. M.; WEBSTER, J. E. & GUDJIAN, E. S. - A note on the use of methylmethacrylate for sealing the bony portion of a cranionasal fistula. J. Neurosurg. 17:355-356, 1960.

[33] 33. TROTOT, R. P. & COR-BEIL, R. - Réparation des brèches craniennes à l'aide de plaques de résine acry-lique. Presentation de malades. Rev. neurol. 79:426-427, 1947.

[34] 34. URIST, M. R. & McLEAN, F. C. - The local phisiology of bone repair. With particular reference to the process of new bone formation by induction. Amer. J. Surg. 85:444-449, 1953.

[35] 35. WEIFORD, E. C. & GARDNER, W. J. - Tantalum cranioplasty. Review of 116 cases in civilian practice. J. Neurosurg. 6:13-32, 1949.

[36] 36. WLAHO-VITCH, B. & GARREL, A. - La prothèse dans les cranioplasties. Montpellier méd. 53(2):292-304, 1958.

[37] 37. WOLFF, J. I. & WALKER, A. E. - Cranioplasty. Coletive review. Int. Abstr. Surg. 81:1-23, 1945.

[38] 38. WORINGER, E.; SCHWIEG, G. & SCHNEIDER, J. - Nouvelle technique ultra-rapide pour la réfection de brèches osseuses craniennes ã la résine acrylique. Avantages de la resine acrylique sur le tantale. Rev. neurol. 85:527-535, 1951.

[39] 39. WORINGER, E. - Nouvelle technique ultra-rapide pour la fermeture de brèches craniennes avec une résine acrylique autopolymérizable. Acta chir. belg. 51:655-659, 1952.

Brasil

Brasil

Cranioplastias e correção de rinoliquorréias com metilmetacrilato: considerações a propósito de 35 casos

Cranioplasties and repair of cerebrospinal fluid rhinorrhea with methylme-thacrylate: comments on 35 cases

Resumos

Cranioplastias e correção de rinoliquorréias com metilmetacrilato. Considerações a propósito de 35 casos

Datas de Publicação