Implantation of Codubix® CT cranial prosthesis 2014 04 07 Latvia

Report: Implantation of Codubix® 3D cranial prosthesis 2014 04 07 - Viola Lāme – Riga, Latvia

1. Place – Riga, Latvia

Operation place: 

Riga Eastern Clinical University Hospital

2 Hipokrata Street, Riga, LV-1038

https://www.aslimnica.lv

The hospital is one of the major hospitals in Latvia

The neurosurgical ward has 50 beds for patients, including 4 rooms with a higher level of comfort and a modern intensive care, providing ongoing monitoring and treatment of postoperative patients.

In the “Gaiļezers” hospital, there are two operating theatres with modern equipment for operating neurosurgical patients (intraoperative ultrasound, neuronavigation, 2 operating microscopes, endoscopic equipment), which is used to perform more than 1,000 operations with varying levels of difficulty.

The neurosurgical department is the basis for the education of students and doctors in Riga.

Head of department Dr. Kārlis Bicāns – certified neurosurgeon.

2. Patient’s medical history

A 30-year-old woman working in Germany three years ago suffered a raptured aneurysm, resulting in severe complications. Although it was possible to use interventional radiology – which allows to heal these types of injuries in a more gentle way and is more beneficial for the patients’ condition – in a German clinic the patient underwent a major surgery. To access the brain pathology the frontal skull bone was opened and removed. After the surgery, the bone fragment did not want to heal in.

After returning to Latvia, the woman reported to the neurosurgical department of the Eastern Hospital with permanent secretion of fluids from the wound.

The patient’s neurosurgeon Dmitrij Gavriļin reported that during further testing the patient was diagnosed with extensive inflammation of the frontal bone.

In such a situation it was necessary to urgently perform an operation to remove the damaged part of the skull to prevent further inflammation and damage to the brain. During the removal of the above-mentioned problem, a new problem arouse – the brain in the frontal part lost its protection, which was the frontal bone. The brain was only covered with skin. Besides, there was a cosmetic defect problem.

3. Preoperative actions

  • The patient’s doctor, Dmitrij Gavriļin, learned about the Codubix skull bone prosthesis after a Tricomed products presentation performed by a TZMO medical representative for the department of neurosurgery. At the beginning of December 2013 he suggested the prosthesis to the patient.
  • In 2013 Dr. D. Gavriļin assisted in a similar operation. The prosthesis was made ​​in Italy, but its cost compared to Codubix 3D was much higher.
  • Under the guidance of a medical representative all the necessary computer images were taken  (the patient went to the hospital on 11/12/2013). The photos were sent to the Tricomed company. The prosthesis production was initiated.
  • As it was a very complicated medical, Tricomed experts in collaboration with Dr. D. Gavriļin wondered whether to prepare a one- or two-piece prosthesis. Eventually it was decided to perform a one-piece prosthesis.

3D model:
Area to be covered with the prothesis
: 143 cm2

                               

4. Operation course

The operation was performed on 07/04/2014 (at first the operation was scheduled on 21/03/2014 but it was postponed due to the patient’s condition – inflammation of head skin. The operation was performed by neurosurgeon Dmitrijs Gavriļins, anaesthesiologist Rūta Kemm. Doctor of medical sciences Piotr Kasprzak from Norbert Barlicki University Hospital No. 1. in Łodź (Poland) and doctor of medical sciences Zbigniew Kotwica participated in the operation as consultants from Poland.

The operation lasted for about 2.5 hours.

The prosthesis was very precisely adjusted. The doctor conducted only a one small correction using special scissors.

Before the operation

During the operation

Prepared prosthesis

During the operation

During the operation / Prepared prosthesis

Preparing the place for the prosthesis

During the operation / Fixing the prosthesis

After the operation

Doctors assessed the patient’s condition as stable. On 25 April 2014 the patient got an excerpt from the hospital. In the near future the patient’s condition will be evaluated on an outpatient basis.

https://www.aslimnica.lv

Press release:

23/04/2014
Using the latest technology, for the first time Latvian neurosurgeons perform a major reconstruction of skull bone defects using a 3D prosthesis.

In the Eastern Clinical University Hospital, in the neurosurgical ward, before Easter, a unique operation was performed, during which a patient with a large skull bone defect had a 3D prosthesis implanted, which replaced the patient’s missing frontal bone.

A 30-year-old woman working in Germany three years ago suffered a raptured aneurysm, resulting in severe complications. Although it was possible to use interventional radiology – which allows to heal these types of injuries in a more gentle way and is more beneficial for the patients’ condition – in a German clinic the patient underwent a major surgery. To access the brain pathology the frontal skull bone was opened and removed. Unfortunately, after the surgery, the bone fragment did not want to heal in. After returning to Latvia, the woman reported to the neurosurgical department of the Eastern Hospital with permanent secretion of fluids from the wound.

Dmitrij Gavriļin: “In such a situation it was necessary to urgently perform an operation to remove the damaged part of the skull to prevent further inflammation and damage to the brain. During the removal of the above-mentioned problem, a new problem arouse – the brain in the frontal part lost its protection, which was the frontal bone. The brain was only covered with skin. Besides, there was a cosmetic defect problem.”

Head of the neurosurgical department Kārlis Bicāns claims that in such cases they use a plastic prosthesis, which is adjusted by hand during the operation: “In this particular case, this method would not give the desired effect. That is why, taking into account international experience, we decided to use the CODUBIX 3D prosthesis, prepared with the use of modern technologies. The prosthesis exactly fits the patient’s bone loss, providing a significantly better cosmetic effect. “

To carry out this unique operation, preparations started a few weeks before the planned surgery – thorough scanning of the patient’s skull was performed, the data were sent to the Polish company TRICOMED SA, which produces medical prostheses (www.codubix.com); the company belongs to the TZMO Group. The company has special hardware and software to prepare the frontal bone defect model in 3D. Due to the fact that this type of operation was carried out in Latvia for the first time, the prosthesis was funded by the Polish partners.

The operation was carried out by a team of neurosurgeons: Dmitrijs Gavriļins, Kārlis Bicāns and an anaesthesiologist: Rūta Ķemme, as well as Polish colleagues, participating in the operation as consultants.

The neurosurgical department in the Eastern Clinical University Hospital in Riga is one of the leading hospitals and provides help for patients with neurosurgical injuries, including very complex cases. Yearly, the department treats about 2,000 patients.

5. After the operation

  • Doctor D. Gavriļins admits that the advantage of the Codubix 3D prosthesis is the immediate result – both medical and cosmetic.
  • The prosthesis closely fills the missing bone part, thereby reconstructing the skull.
  • The operation time is reduced due to the fact that the shape of the prosthesis in 99.9% fits the defect contour, so there is no need for additional adjustment of the prosthesis.
  • The doctor and the patient are satisfied with the result of the operation.

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