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Haque F, Luscher AF, Mitchell KAS, Sutradhar A. Optimization of Fixations for Additively Manufactured Cranial Implants: Insights from Finite Element Analysis. Biomimetics (Basel) 2023; 8:498. [PMID: 37887630 PMCID: PMC10603949 DOI: 10.3390/biomimetics8060498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/01/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
With the emergence of additive manufacturing technology, patient-specific cranial implants using 3D printing have massively influenced the field. These implants offer improved surgical outcomes and aesthetic preservation. However, as additive manufacturing in cranial implants is still emerging, ongoing research is investigating their reliability and sustainability. The long-term biomechanical performance of these implants is critically influenced by factors such as implant material, anticipated loads, implant-skull interface geometry, and structural constraints, among others. The efficacy of cranial implants involves an intricate interplay of these factors, with fixation playing a pivotal role. This study addresses two critical concerns: determining the ideal number of fixation points for cranial implants and the optimal curvilinear distance between those points, thereby establishing a minimum threshold. Employing finite element analysis, the research incorporates variables such as implant shapes, sizes, materials, the number of fixation points, and their relative positions. The study reveals that the optimal number of fixation points ranges from four to five, accounting for defect size and shape. Moreover, the optimal curvilinear distance between two screws is approximately 40 mm for smaller implants and 60 mm for larger implants. Optimal fixation placement away from the center mitigates higher deflection due to overhangs. Notably, a symmetric screw orientation reduces deflection, enhancing implant stability. The findings offer crucial insights into optimizing fixation strategies for cranial implants, thereby aiding surgical decision-making guidelines.
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Affiliation(s)
- Fariha Haque
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH 43210, USA; (F.H.); (A.F.L.)
| | - Anthony F. Luscher
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH 43210, USA; (F.H.); (A.F.L.)
| | - Kerry-Ann S. Mitchell
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Alok Sutradhar
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH 43210, USA; (F.H.); (A.F.L.)
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Limaye N, Veschini L, Coward T. Assessing biocompatibility & mechanical testing of 3D-printed PEEK versus milled PEEK. Heliyon 2022; 8:e12314. [PMID: 36590483 PMCID: PMC9800332 DOI: 10.1016/j.heliyon.2022.e12314] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives To compare mechanical properties of 3D-printed and milled poly-ether-ether-ketone (PEEK) materials. To define post-production treatments to enhance biocompatibility of 3D-printed PEEK. Methods Standardised PEEK samples were produced via milling and fused-deposition-modelling 3D-printing. To evaluate mechanical properties, tensile strength, maximum flexural strength, fracture toughness, and micro-hardness were measured.3D printed samples were sandblasted with 50 or 125 μm aluminium oxide beads to increase biocompatibility.Scanning electron microscopy (SEM) evaluated microstructure of 3D-printed and sandblasted samples, estimating surface roughness at scales from 1mm-1μm.Cell adhesion on 3D printed and sandblasted materials was evaluated by culturing primary human endothelial cells and osteoblasts (HUVEC, HOBS) and evaluating cell growth over 48 h. Results 3D printed materials had lower tensile strength, flexural strength, and fracture toughness, but higher micro-hardness.SEM analysis of 3D-printed surfaces showed sandblasting with 125 and 50 μm silica particles removed printing defects and created roughened surfaces for increased HUVEC and HOBs uniform cell adhesion and distribution. No cytotoxicity was observed over a 48h period, and all cells demonstrated >95% viability. Clinical significance 3D-printing of PEEK is an emerging technology with clear advantages over milling in maxillofacial implant production. Nonetheless, this manufacturing modality may produce 3D printed PEEK devices with lower mechanical resistance parameters compared to milled PEEK but with values compatible with natural bone. PEEK has poor osteoconductivity and ability to osseointegrate. Sandblasting is an inexpensive modality to remove irregular surface defects and create uniform micro-rough surfaces supporting cell attachment and potentially enhancing integration of PEEK implants with host tissue.
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Hevia Rodríguez P, Samprón N, Plou García MP, Elúa Pinín A, Úrculo Bareño E. Atypical facial pain after cranioplasty: A too perfect design?: Dolor facial atípico asociado a craneoplastia: ¿un encaje demasiado perfecto? NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:361-365. [PMID: 35256328 DOI: 10.1016/j.neucie.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/01/2021] [Accepted: 07/11/2021] [Indexed: 06/14/2023]
Abstract
Cranioplasty is a procedure routinely performed in neurosurgery. It is associated with significant morbidity and several types of postsurgical complications. The most common are infections, bone flap resorption and hematomas. Atypical facial pain has not been documented yet as a potential postoperative complication. We present a case of atypical facial pain reported at inmediate postoperative period after cranioplasty. The pain was refractory to medical treatment and sphenopalatine ganglion block. Eventually, the pain totally disappeared after surgical revision of the cranial implant.
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Affiliation(s)
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - María Pilar Plou García
- Servicio de Unidad del Dolor, Anestesiología y Reanimación, Hospital Universitario Donostia, San Sebastián, Spain
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Selvaraj S, Dorairaj J, Shivasankar N. 3d cranial reconstruction using titanium implant - a case report. Afr Health Sci 2022; 22:383-390. [PMID: 36910405 PMCID: PMC9993297 DOI: 10.4314/ahs.v22i3.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cranioplasty is a neurosurgical procedure done to cover the defective or deficient skull bone. The cranial reconstruction rejuvenates the patient by protecting and restore intracranial structures and pressure thus improving the esthetic appearance. Thus improves the neurological and psychological wellbeing of the patient. The blending Advancement of computer technology in medical and dental science allowed the 3D reconstruction of several anatomical structures for various medical procedures by designing the custom-made implants. Procedure This case report describes the methodology used to design a custom-made cranial implant for a 38-year-old patient who had traumatic injury in the right temporosagital region of the skull caused by a road traffic accident . 3D reconstruction of the cranial vault was done using CAD designing and Selective laser melting (SLM) technology printing. Discussion The presicion of the prosthesis was good thereby the surgical time was reduced and eliminates any errors in operating theatre and successfully implanted. The patient's esthetics was restores , allowing the patient to safely perform daily activities with full confidence. Conclusion The use of 3D reconstruction techniques in managing exhaustive surgeries aids to reduces the possibility of errors during surgery, precise and passive fit and provides better implant stability. Thus 3D printing technology has boomed its use in various field of medicine.
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Sinclair S, Zhou K, Yip JM, Aggarwal S, Jukes A, Clark JR, Shivalingham B, Ch'ng S. Microsurgical scalp reconstruction and cranioplasty refined. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Microsurgical free flap scalp reconstruction is commonly the only reconstructive option in certain challenging patient cohorts. We describe the technical refinements that have streamlined our ap-proach to microsurgical scalp reconstruction and cranioplasty.
Methods: Virtual surgical planning for multiple failed cranioplasty cases involves fashioning an implant with a 3 mm offset. Intramuscular dissection of the latissimus dorsi (LD) vascular pedicle, distal to its bifurcation, is routinely performed, and can increase pedicle length by up to 4 cm without the need for tedious dissec-tion in the axilla. Anastomoses to the superficial temporal vessels distal to their bifurcation in the parietal scalp are reliable and safe. The sequence of surgery is in reverse to the conventional sequence, with the free flap vascularised before craniectomy/cranioplasty is performed to decrease the duration of synthetic im-plant exposure.
Results: Thirty-nine cases were performed in 35 patients over a five-year period. An LD-based free flap in various permutations was the commonest free flap option (n = 31). The superficial temporal artery and vein were choice recipient vessels in 82 per cent and 74 per cent of cases, respectively, with the former demon-strating higher anatomical consistency. Complications included free flap venous congestion successfully salvaged (n = 1), infected polymethylmethacrylate cranioplasty requiring explantation (n = 1), subdural haematoma requiring craniotomy for evacuation (n = 1) and free flap donor site haematoma (n = 2).
Conclusion: Our technical refinements offer a streamlined and reliable procedure of complex scalp recon-struction and cranioplasty.
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Bouzidi S, Ayadi M, Boulila A. Feasibility Study of the SPIF Process Applied to Perforated Sheet Metals. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2022. [DOI: 10.1007/s13369-022-06570-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reconstruction of Cranial Bone Defects Using Polyamide 12 Patient-Specific Implant: Long Term Follow Up. J Craniofac Surg 2022; 33:1825-1828. [PMID: 35119415 DOI: 10.1097/scs.0000000000008496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The main objective of this study was to evaluate the use of patient-specific polyamide 12 implants in cranial bone defect reconstruction.Ten patients who underwent prior decompression craniectomy were selected for the current study. Skull scanning by computerized tomography was performed and used to make virtual planning of the implants to be transformed into physical implant using selective laser sintering. Cranioplasty was performed through coronal surgical approach where cranial implants were fixated using 2.0-mm mini-screws, and plates. Patients follow-up was from 12 to 36 months. Glasgow Outcome Score recorded 1 (good recovery) for all patients. Patient and surgeon satisfaction for the esthetic outcome were measured using visual analog scale as mean of 10 ± 0 and 9 ± 1, respectively. Cranial symmetry index was calculated as mean score of 98% ± 1%, indicating highly accurate symmetry, and preoperative virtual planning and postoperative outcome were compared for accuracy analysis with a mean difference of 0.3197 ± 0.1649, which indicates high accuracy.Polyamide12 cranial implants seem to offer a promising option to cranial bone reconstruction with patient-specific implants. This study ensures proper cosmetic and clinical outcome.
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Colverde AS, Nicetto T, Falzone C. Occipital cranioplasty using customized titanium prosthesis yields successful outcome in association with foramen magnum decompression in dogs suffering by Chiari-like malformation. Am J Vet Res 2021; 83:275-282. [PMID: 34968186 DOI: 10.2460/ajvr.21.11.0178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the use of a customized 3-D-printed titanium prosthesis as adjunctive treatment for foramen magnum decompression (FMD) in dogs with Chiari-like malformation (CM) and syringomyelia (SM). ANIMALS 8 dogs with clinical signs and MRI findings of CM-SM. PROCEDURES 3-D reconstruction of CT images of the head was used to simulate an occipital craniectomy and design the prosthesis. FMD was performed, and the prosthesis was implanted. Follow-up was performed 1, 6, and 12 months later, and clinical status was scored. Repeated MRI images were compared to identify changes involving the neural structures, particularly the syrinx. RESULTS All prostheses were easily positioned based on the preoperative 3-D models, with no complications. At 12 months after surgery, 3 dogs were free of previous medications, 4 were still receiving steroid medications but at lower doses, and 1 was occasionally receiving acupuncture. MRI of 5 dogs 6 to 20 months after surgery revealed resolution of SM (n = 1), reduced size of SM (3), or worse SM (1). All dogs showed an increase in size of the caudal cranial fossa. Dogs with a longer presurgical duration of the clinical signs and wider syrinx generally had worse outcomes than other dogs. CLINICAL RELEVANCE Findings suggested that use of customized 3-D-printed titanium prosthesis and associated FMD can represent an adjunctive option to medically treated dogs with CM-SM. Although the small number of cases precludes definitive conclusions, early surgical treatment, particularly in dogs with a small syrinx, could ensure better long-term outcomes, as previously suggested.
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Sharma N, Aghlmandi S, Dalcanale F, Seiler D, Zeilhofer HF, Honigmann P, Thieringer FM. Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants. Int J Mol Sci 2021; 22:8521. [PMID: 34445228 PMCID: PMC8395180 DOI: 10.3390/ijms22168521] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 12/18/2022] Open
Abstract
Recent advancements in medical imaging, virtual surgical planning (VSP), and three-dimensional (3D) printing have potentially changed how today's craniomaxillofacial surgeons use patient information for customized treatments. Over the years, polyetheretherketone (PEEK) has emerged as the biomaterial of choice to reconstruct craniofacial defects. With advancements in additive manufacturing (AM) systems, prospects for the point-of-care (POC) 3D printing of PEEK patient-specific implants (PSIs) have emerged. Consequently, investigating the clinical reliability of POC-manufactured PEEK implants has become a necessary endeavor. Therefore, this paper aims to provide a quantitative assessment of POC-manufactured, 3D-printed PEEK PSIs for cranial reconstruction through characterization of the geometrical, morphological, and biomechanical aspects of the in-hospital 3D-printed PEEK cranial implants. The study results revealed that the printed customized cranial implants had high dimensional accuracy and repeatability, displaying clinically acceptable morphologic similarity concerning fit and contours continuity. From a biomechanical standpoint, it was noticed that the tested implants had variable peak load values with discrete fracture patterns and failed at a mean (SD) peak load of 798.38 ± 211.45 N. In conclusion, the results of this preclinical study are in line with cranial implant expectations; however, specific attributes have scope for further improvements.
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Affiliation(s)
- Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031 Basel, Switzerland;
| | - Federico Dalcanale
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts North-Western Switzerland, CH-4132 Muttenz, Switzerland; (F.D.); (D.S.)
| | - Daniel Seiler
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts North-Western Switzerland, CH-4132 Muttenz, Switzerland; (F.D.); (D.S.)
| | - Hans-Florian Zeilhofer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
| | - Philipp Honigmann
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Hand Surgery, Cantonal Hospital Baselland, CH-4410 Liestal, Switzerland
- Amsterdam UMC, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam Movement Sciences, NL-1105 Amsterdam, The Netherlands
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
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Hevia Rodríguez P, Samprón N, Plou García MP, Elúa Pinín A, Úrculo Bareño E. Dolor facial atípico asociado a craneoplastia: ¿un encaje demasiado perfecto? Neurocirugia (Astur) 2021. [DOI: 10.1016/j.neucir.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Sharma N, Ostas D, Rotar H, Brantner P, Thieringer FM. Design and Additive Manufacturing of a Biomimetic Customized Cranial Implant Based on Voronoi Diagram. Front Physiol 2021; 12:647923. [PMID: 33897455 PMCID: PMC8063040 DOI: 10.3389/fphys.2021.647923] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/15/2021] [Indexed: 12/21/2022] Open
Abstract
Reconstruction of cranial defects is an arduous task for craniomaxillofacial surgeons. Additive manufacturing (AM) or three-dimensional (3D) printing of titanium patient-specific implants (PSIs) made its way into cranioplasty, improving the clinical outcomes in complex surgical procedures. There has been a significant interest within the medical community in redesigning implants based on natural analogies. This paper proposes a workflow to create a biomimetic patient-specific cranial prosthesis with an interconnected strut macrostructure mimicking bone trabeculae. The method implements an interactive generative design approach based on the Voronoi diagram or tessellations. Furthermore, the quasi-self-supporting fabrication feasibility of the biomimetic, lightweight titanium cranial prosthesis design is assessed using Selective Laser Melting (SLM) technology.
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Affiliation(s)
- Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (SwissMAM), University of Basel, Allschwil, Switzerland
| | - Daniel Ostas
- Department of Oral and Cranio-Maxillofacial Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu Rotar
- Department of Oral and Cranio-Maxillofacial Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Philipp Brantner
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (SwissMAM), University of Basel, Allschwil, Switzerland.,Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Florian Markus Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (SwissMAM), University of Basel, Allschwil, Switzerland
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Huys SEF, Van Gysel A, Mommaerts MY, Sloten JV. Evaluation of Patient-Specific Cranial Implant Design Using Finite Element Analysis. World Neurosurg 2021; 148:198-204. [PMID: 33529765 DOI: 10.1016/j.wneu.2021.01.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Various studies have investigated the load-bearing capacity of patient-specific cranial implants. However, little attention has been given to the evaluation of the design of ceramic-titanium (CeTi) implants. METHODS A biomechanical evaluation of 3 patient-specific cranial implants was performed using finite element analysis. RESULTS The results of the analyses allowed the identification of the implant regions as well as the magnitudes of the maximum stresses on, and displacements along, these regions after traumatic impact. The analyses also showed that polyether ether ketone cranial implants offer inferior brain and neurocranial protection due to their high flexibility and local peak stresses at the bone-screw interface. In contrast, CeTi implants were able to evenly distribute the stresses along the interface and thus reduced the risk of neurocranial fracture. The scaffold structure at the border of these implants reduced stress shielding and enhanced bone ingrowth. Moreover, brain injuries were less likely to occur, as the CeTi implant exhibits limited deflection. CONCLUSIONS From the finite element analyses, CeTi cranial implants appear less likely to induce calvarial fractures with a better potential to protect the brain under impact loads.
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Affiliation(s)
- Stijn E F Huys
- Engineering Science, Department of Mechanical Engineering, Section of Biomechanics, Catholic University of Leuven, Leuven, Belgium
| | - Anke Van Gysel
- Engineering Science, Department of Mechanical Engineering, Section of Biomechanics, Catholic University of Leuven, Leuven, Belgium
| | - Maurice Y Mommaerts
- 3D Innovations Laboratory, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Jos Vander Sloten
- Engineering Science, Department of Mechanical Engineering, Section of Biomechanics, Catholic University of Leuven, Leuven, Belgium
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Mommaerts MY, Depauw PR, Nout E. Ceramic 3D-Printed Titanium Cranioplasty. Craniomaxillofac Trauma Reconstr 2020; 13:329-333. [PMID: 33456704 PMCID: PMC7797988 DOI: 10.1177/1943387520927916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN Inlay cranioplasties following partial craniectomy in tumor or trauma cases and onlay cranioplasties for reconstructions of residual developmental skull anomalies are frequently performed using CAD-CAM techniques. OBJECTIVE In this case series, we present a novel cranial implant design, being a combination of 3D-printed titanium grade 23 and calcium phosphate paste (CeTi). METHODS The titanium patient-specific implant, manufactured using selective laser melting, has a latticed border with interconnected micropores. The cranioplasty is miniscrew fixed and its border zone subsequently partially filled with calcium phosphate paste to promote osteoinduction and osteoconduction. From April 2017 to April 2019, 8 patients have been treated with such a CeTi implant. The inlay cranioplasties were each time revision surgeries of complicated cases. RESULTS All implants were successful after a limited follow-up time (range 18-42 months). There were no dehiscences and no infections, and no complaints of thermal conduction. CONCLUSIONS The proposed CeTi cranial implant combines the strength of titanium implants with the biological integration potential of ceramic implants and seems particularly resistant to infection, probably due to the biofunctionalized titanium surface and the antimicrobial activity of elevated intracellular free calcium levels.
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Affiliation(s)
- Maurice Y. Mommaerts
- European Face Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Paul R. Depauw
- Department of Neurosurgery, GH Elisabeth-Tweesteden, Tilburg, The Netherlands
| | - Erik Nout
- Division of Oro-Maxillo-Facial Surgery, GH Elisabeth-Tweesteden, Tilburg, The Netherlands
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Kuwabara A, Duong T. Low-Profile Asymmetric Polyetheretherketone Cranioplasty to Bypass Tissue Expansion. PM R 2020; 13:333-335. [PMID: 32274849 DOI: 10.1002/pmrj.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Anne Kuwabara
- Department of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA, USA
| | - Thao Duong
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA
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Cosmetic and Neuroprotective Placement of Custom-Made Ultra-High-Molecular-Weight Polyethylene Cranial Plate (SKULPIO) in Single-Step Surgery: Technical Note and Case Report. World Neurosurg 2019; 130:187-191. [PMID: 31299307 DOI: 10.1016/j.wneu.2019.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cranioplasty is a common procedure in neurosurgery. However, cosmetic and neuroprotective reconstructions are necessary after cranioplasty. Treatment of patients with a meningioma with bone infiltration requires removal of the tumor-infiltrated bone and subsequent cranioplasty. We report an efficient technique for cosmetic and neuroprotective reconstructions using a custom-made ultra-high-molecular-weight polyethylene cranial plate (SKULPIO, Kyocera Medical, Kyoto, Japan) in a single-step surgery involving tumor removal and skull reconstruction. METHODS We present 2 illustrative cases of a 49-year-old female with a right frontal convexity meningioma and 69-year-old male with a bilateral parasagittal atypical meningioma, both involving extensive skull invasion. We preoperatively planned craniotomy size to facilitate the removal of the tumor-infiltrated skull bone using the patients' 3-dimensional cranial models followed by the construction of a custom-made cranial plate. After tumor removal, we drilled out the outer table and the diploe of the cranial edge until the custom-made bone plate accurately fit the bone defect. Finally, the cranial plate was fixed using titanium plates and screws. RESULTS Postoperative magnetic resonance imaging for each case revealed total meningioma removal and an aesthetically reconstructed skull. Using this technique, precise adjustment of the cranial edge to the plate contributes to a gapless and aesthetic reconstruction. Furthermore, the intact inner table of the skull firmly supports the custom-made bone plate. CONCLUSIONS This technique involving the placement of a custom-made cranial plate during a single-step surgery was found to be efficient for cosmetic and neuroprotective reconstructions.
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Abstract
Historically, the approach to pediatric cranioplasty has been largely extrapolated from the treatment of adults. More recently, however, the intricacies of pediatric cranial reconstruction have become better understood, and the surgical management has been refined contemporaneously. Each patient's cranial defect bears a unique set of challenges and, as such, the choice of cranioplasty technique must be tailored accordingly.
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Affiliation(s)
- Michael R Bykowski
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 664 Scaife Hall, Pittsburgh, PA 15261, USA
| | - Jesse A Goldstein
- Department of Plastic Surgery, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion, Floor 7, Pittsburgh, PA 15224, USA
| | - Joseph E Losee
- Department of Plastic Surgery, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion, Floor 7, Pittsburgh, PA 15224, USA.
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17
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Wolff A, Santiago GF, Huang J, Gordon C. Letter to the editor: "Considerations in computer-aided design for inlay cranioplasty: technical note". Oral Maxillofac Surg 2018; 22:117-118. [PMID: 29397448 DOI: 10.1007/s10006-018-0683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Amir Wolff
- Department of Oral Maxillofacial Surgery, Rambam Medical Center, Technion Institute of Technology, Haifa, Israel. .,Department of Plastic-Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St, JHOC 8th floor, Baltimore, MD, 21287, USA. .,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Gabriel F Santiago
- Department of Plastic-Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St, JHOC 8th floor, Baltimore, MD, 21287, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chad Gordon
- Department of Plastic-Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St, JHOC 8th floor, Baltimore, MD, 21287, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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