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Advanced Neurology

REVIEW ARTICLE
Outcomes of surgical management and implant

consideration for depressed skull fractures: A
systematic review

2
1
1
Andrew Nguyen , Akshay Reddy , Ramy Sharaf , Lauren Ladehoff ,
1
1
Michael Joseph Diaz , and Brandon Lucke-Wold *
3
1 College of Medicine, University of Florida, Gainesville, Florida, USA
2 College of Medicine, University of South Florida, Tampa, Florida, USA
3 Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
ABSTRACT

Background: Traumatic brain injuries (TBIs) are associated with high mortality and
morbidity. Depressed skull fractures (DSFs) are a subset of fractures characterized by
either direct or indirect brain damage, compressing brain tissue. Recent advances in
implant use during primary reconstruction surgeries have shown to be effective. In
this systematic review, we assess differences in titanium mesh, polyetheretherketone
(PEEK) implants, autologous pericranial grafts, and methyl methacrylate (PMMA)
implants for DSF treatment.
Methods: A literature search was conducted in PubMed, Scopus, and Web of Science
from their inception to September 2022 to retrieve articles regarding the use of
*Corresponding author: various implant materials for depressed skull fractures. Inclusion criteria included
Brandon Lucke-Wold studies specifically describing implant type/material within treatment of depressed
(Brandon.Lucke-Wold@
neurosurgery.ufl.edu) skull fractures, particularly during duraplasty. Exclusion criteria were studies reporting
only non-primary data, those insufficiently disaggregated to extract implant type,
Citation: Nguyen A, Reddy A, those describing treatment of pathologies other than depressed skull fractures, and
Sharaf R. et al., 2023, Outcomes of
surgical management and implant non-English or cadaveric studies. The Newcastle-Ottawa Scale was utilized to assess
consideration for depressed skull for presence of bias in included studies.
fractures: A systematic review. Adv Results: Following final study selection, 18 articles were included for quantitative
Neuro, 2(1): 247.
https://doi.org/10.36922/an.247 and qualitative analysis. Of the 177 patients (152 males), mean age was 30.8 years
with 82% implanted with autologous graft material, and 18% with non-autologous
Received: November 2, 2022
material. Data were pooled and analyzed with respect to the total patient set, and
Accepted: January 16, 2023 additionally stratified into those treated through autologous and non-autologous
Published Online: February 3, implant material. There were no differences between the two cohorts regarding mean
2023 time to encounter, pre-operative Glasgow coma scale (GCS), fracture location, length
Copyright: © 2023 Author(s). to cranioplasty, and complication rate. There were statistically significant differences
This is an Open Access article in post-operative GCS (p < 0.0001), LOS (p = 0.0274), and minimum follow-up time
distributed under the terms of the (p = 0.000796).
Creative Commons Attribution
License, permitting distribution, Conclusion: Differences in measurable post-operative outcomes between implant
and reproduction in any medium, groups were largely minimal or none. Future research should aim to probe these
provided the original work is basic results deeper with a larger, non-biased sample.
properly cited.
Publisher’s Note: AccScience
Publishing remains neutral with Keywords: Autologous graft; Non-autologous graft; Implant material; Cranioplasty;
regard to jurisdictional claims in Depressed skull fracture; Duraplasty
published maps and institutional
affiliations.

Volume 2 Issue 1 (2023) 1 https://doi.org/10.36922/an.247