CustomBone Service Resistance to Post-Operative Infections in Paediatric Population
We would like to inform you about CustomBone Service Resistance to Post-Operative Infections in Paediatric Population
In paediatric population (infant and children, 0-7 yrs), the skull is growing and the bony contour is dynamic1. This places specific constraints on materials that can be used for cranial vault reconstruction, which should grow with the skull, be durable for a long period and have a high resistance to late infection. The autologous bone is the gold standard in this population, even if resorption risk of autologous bone ranges between 20-50% 1. When autologous bone is not available osteointegrative solutions as CustomBone Service are preferred.This is supported by a number of clinical evidences and publications reporting low post-operative infection rate, very good osteointegrative properties, restoration of the normal intracranial physiology and excellent cosmetic outcomes2,3,4,5,6 (Figure 1, Figure 2 and Figure 3).
Figure 1 - On the Left: Preoperative picture. On the Right: cranial three-dimensional computed tomography scan
Figure 2 - On the Left: Clinical appearance of the patient 10 months after the operation. On the Right: CT scan 40 months showing excellent osteointegration and cosmetic results
Figure 3 - Post-craniectomy study of the cerebral blood flow. A-B: right-left asymmetry with a hypoperfusion of the left hemisphere. C – D: Post-cranioplasty study of the cerebralblood flow. Note that the right-left asymmetry has disappeared and that the global brain blood flow has increased.
CustomBone Service is a patient-specific cranial implant made of hydroxyapatite (HA). The porous structure, which resembles the mineral component of human bone, plays a key-role during osteointegration, making the material suitable for cells housing. In the worst scenario of post-operative infections, the porous structure allows the device to be treated locally with antibiotics, thus avoiding the prosthesis removal.
Porous Hydroxyapatite is a valid bioceramic material and its application should be further explored, not only for neurosurgical applications. For what concern its application for cranial reconstruction, this heterologous material seems to be at least as valid as other materials actually present on the market for what concerns the postoperative clinical outcomes.
When used in children (CustomBone is indicated for children above 2 years in EMEA and above 7 years in US under the name of CustomizedBone Service), CustomBone features the same osteointegrative properties highlighted in adults.
References:
[1] Frassanito, P. et al.”The growth of the neurocranium: literature review and implications in cranial repair” Childs Nerv Syst (2019) (https://pubmed.ncbi.nlm.nih.gov/31089851/)
[2] Klieverik, V. M., et al. “Cranioplasty after craniectomy in pediatric patients-a systematic review” Childs Nerv Syst (2019).
(https://pubmed.ncbi.nlm.nih.gov/30610476/)
[3] Frassanito, P. et al. “Custom-made hydroxyapatite for cranial repair in a specific pediatric age group (7-13 years old): a multicenter post-marketing surveillance study” Childs Nerv Syst (2018)
(https://pubmed.ncbi.nlm.nih.gov/29987377/)
[4] Frassanito, P. et al. “Problems of reconstructive cranioplasty after traumatic brain injury in children” Childs Nerv Syst (2017). (https://pubmed.ncbi.nlm.nih.gov/29149388/)
[5] Beuriat, P.-A., et al. “Why a hydroxyapatite cranioplasty can be used to repair a cranial bone defect in children: Experience of 19 cases” Neurochirurgie (2016) (https://pubmed.ncbi.nlm.nih.gov/27543986/)
[6] Beuriat, P.-A. et al. “Repair of Cranial Bone Defects in Children Using Synthetic Hydroxyapatite Cranioplasty (CustomBone)” World Neurosurg (2019). (https://pubmed.ncbi.nlm.nih.gov/31100525/)