Among all types of injuries, traumatic brain injuries often leave severe consequences, leading to death or disability for the victims. Many survivors have skull defects, with the brain tissue underneath protected only by a thin layer of skin and soft tissue. Additionally, workplace accidents, skull pathologies such as skull tumors, war injury sequelae, and complications after surgeries to treat brain conditions contribute to a significant number of patients. The lack of a protective skull creates a condition known as “Skull Blood Syndrome“, characterized by symptoms such as headaches, dizziness, and nausea when changing positions or with weather changes, particularly in extreme heat or cold, causing anxiety during work and daily activities as they always seek to avoid collisions with hard objects. This can lead to social withdrawal due to aesthetic concerns.
In cases of large skull defects, the underlying brain structure may be altered, thereby affecting brain function. Furthermore, carrying a skull defect can create feelings of inferiority and challenges in integrating into the community.
Research published on 10,466 patients with traumatic brain injuries treated at Chợ Rẫy Hospital shows that more than 60% of the patients are aged between 18 and 35, with a male-to-female ratio of 4.64. For patients aged 18 to 50, they account for up to 72%. Thus, most victims of traumatic brain injuries from traffic accidents in Vietnam are young and of working age. The consequences of traffic accidents not only impact the patients but also have severe repercussions on society as a whole.
Therefore, researching and developing economically viable and technologically effective methods for creating skull replacement pieces is essential to help patients with skull defects reintegrate into the community.
Applied Technical Solutions
Traditional treatment methods for patients with skull defects involved surgeries using pre-made materials such as tantalum, titanium, acrylic, polyethylene, silicone, ceramics, and more recently, composite carbon materials like “intost-2” to cover the defects. Another method currently applied at Military Central Hospital 108 is to create custom pieces (hand-molded) from dental cement (duracry) immediately after exposing the defect area. Over the past four years, doctors here have performed surgeries on more than 60 patients, helping them return to normal life. The advantage of using material pieces is that the skull defect cover can be made on-site. However, this method has some disadvantages:
– It cannot produce large patches in complex regions such as the brow arch or eye socket;
– Being hand-molded in narrow surgical spaces results in uneven surfaces, lacking aesthetic appeal. When using pre-made materials, the aesthetic is also low because their curvature differs from the actual curvature of the patient’s skull. The edges of the graft cannot fit snugly against the skull defect;
– The need to create graft images within a short surgical time can prolong recovery. Additionally, since the grafts are shaped and sterilized quickly, particularly when using polymerizing materials like PMMA, these factors can reduce the biological compatibility and longevity of the grafts;
– Only simple and easy-to-mold biological materials can be used. For materials with high biological compatibility, such as titanium or those derived from hydroxyapatite, creating them during surgery is often difficult, if not impossible.
Risks Associated with Traditional Surgery
In the case of patient Trần Thị T, born on 16/05/1956, she underwent surgery to remove a tuberculosis tumor from the parietal-occipital region on 25/08/1998, and later had a mica plate inserted to cover the defect. Currently, the graft does not fit well with the remaining skull. With weather changes, seasonal shifts, extreme temperatures, storms, or impending rain, there is often increased intracranial pressure, causing the graft region to swell and tense like a bicycle tire, leading to severe vomiting. If not promptly addressed, the patient risks losing muscle tone, language capabilities, and consciousness, becoming completely non-responsive. Failure to manage this could result in full-body seizures. After stabilization treatment, it takes at least 2 to 3 months to restore function to the original state. To remedy this condition, the patient’s family must learn treatment methods and closely monitor the patient to prevent seizures.
Biomedical Technology for Effective Diagnosis and Treatment
Biomedical Engineering is an interdisciplinary field that requires the involvement of experts from various domains such as imaging diagnosis, information technology, mechanics, and surgery. It encompasses the design and production of medical models, surgical assistance tools, implantable components for the human body, and hardware and software solutions to enhance the accuracy and effectiveness of disease diagnosis and treatment.
For the first time in Vietnam, a team of biomedical engineers comprising experts in engineering and medicine has been established and is effectively operational, aiming to apply advanced global technologies in modeling, image processing, graphics, design, and manufacturing to improve disease diagnosis and treatment capabilities in Vietnam.
Since 1999, the Department of Imaging Diagnosis at Hospital 108 has received substantial support in Biomedical Technology from leading global experts. Notably, assistance from the Belgian government, through the Catholic University of Leuven (Professor Jos Vander Sloten), and the proactive transfer and implementation of Biomedical Technology in Vietnam by Dr. Lê Chí Hiếu from Cardiff University, UK. Currently, Hospital 108 has successfully organized a team of specialists from various fields such as imaging diagnosis, neurosurgery, information technology, and mechanics to research, design, manufacture, and implant grafts for patients with skull defects, tailored to the conditions and resources available in Vietnam.
L.Khanh – Medinfo
