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Iratwar S, Roy Chowdhury S, Pisulkar S, Das S, Agarwal A, Bagde A, Paikrao B, Quazi S, Basu B. Comprehensive functional outcome analysis and importance of bone remodelling on personalized cranioplasty treatment using Poly(methyl methacrylate) bone flaps. J Biomater Appl 2024; 38:975-988. [PMID: 38423069 DOI: 10.1177/08853282241235884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Cranioplasty involves the surgical reconstruction of cranial defects arising as a result of various factors, including decompressive craniectomy, cranial malformations, and brain injury due to road traffic accidents. Most of the modern decompressive craniectomies (DC) warrant a future cranioplasty surgery within 6-36 months. The conventional process of capturing the defect impression and polymethyl methacrylate (PMMA) flap fabrication results in a misfit or misalignment at the site of implantation. Equally, the intra-operative graft preparation is arduous and can result in a longer surgical time, which may compromise the functional and aesthetic outcomes. As part of a multicentric pilot clinical study, we recently conducted a cohort study on ten human subjects during 2019-2022, following the human ethics committee approvals from the participating institutes. In the current study, an important aspect of measuring the extent of bone remodelling during the time gap between decompressive craniectomy and cranioplasty was successfully evaluated. The sterilised PMMA bone flaps were implanted at the defect area during the cranioplasty surgery using titanium mini plates and screws. The mean surgery time was 90 ± 20 min, comparable to the other clinical studies on cranioplasty. No signs of intra-operative and post-operative complications, such as cerebrospinal fluid leakage, hematoma, or local and systemic infection, were clinically recorded. Importantly, aesthetic outcomes were excellent for all the patients, except in a few clinical cases, wherein the PMMA bone flap was to be carefully customized due to the remodelling of the native skull bone. The extent of physiological remodelling was evaluated by superimposing the pre-operative and post-operative CT scan data after converting the defect morphology into a 3D model. This study further establishes the safety and efficacy of a technologically better approach to fabricate patient-specific acrylic bone flaps with improved surgical outcomes. More importantly, the study outcome further demonstrates the strategy to address bone remodelling during the patient-specific implant design.
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Affiliation(s)
- Sandeep Iratwar
- Department of Neurosurgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | | | - Shweta Pisulkar
- Department of Prosthodontics, Crown & Bridge, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | - Soumitra Das
- Material Research Centre, Indian Institute of Science, Bangalore, India
| | - Akhilesh Agarwal
- Bio-Innovation cell, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | - Ashutosh Bagde
- Faculty of Engineering Technology, Biomedical Engineering/and Research Scientist, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | - Balaji Paikrao
- Department of Mechanical Engineering, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Syed Quazi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, India
| | - Bikramjit Basu
- Material Research Centre, Indian Institute of Science, Bangalore, India
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Ji T, Yao P, Zeng Y, Qian Z, Wang K, Gao L. Subgaleal Effusion and Brain Midline Shift After Cranioplasty: A Retrospective Study Between Polyetheretherketone Cranioplasty and Titanium Cranioplasty After Decompressive Craniectomy. Front Surg 2022; 9:923987. [PMID: 35937601 PMCID: PMC9351718 DOI: 10.3389/fsurg.2022.923987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/10/2022] [Indexed: 11/21/2022] Open
Abstract
Cranioplasty with polyetheretherketone (PEEK) has recently shown better cerebral protection performance, improved brain function, and aesthetic contour compared with titanium mesh. However, whether patients undergoing PEEK cranioplasty tend to develop subgaleal effusions remains elusive. This retrospective study included patients who underwent cranioplasty with PEEK implants or titanium mesh after decompressive craniectomy between July 2017 and July 2020. Patient information, including general information, location, size of the defect, subgaleal depth, and brain midline shift was collected and statistically analyzed. There were 130 cases of cranioplasty, including 35 with PEEK implants and 95 with a titanium mesh. Patients who underwent cranioplasty with a PEEK implant had a higher subgaleal effusion rate than those who underwent cranioplasty with titanium mesh (85.71% vs. 53.68%, P < 0.001), while a midline shift >5 mm was more frequently observed in the PEEK group than in the titanium group (20% vs. 6.3%, P = 0.021). The PEEK material was the only factor associated with subgaleal effusion after cranioplasty (OR 5.589, P = 0.002). Logistic regression analysis further showed that age was a protective factor against midline shift in the PEEK cranioplasty group (OR 0.837, P = 0.029). Patients who underwent cranioplasty with PEEK implants were more likely to develop severe subgaleal effusion and significant brain midline shifts than those with titanium mesh implants.
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Affiliation(s)
- Tao Ji
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Peiwen Yao
- School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yu Zeng
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Zhouqi Qian
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Ke Wang
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
- Correspondence: Liang Gao Ke Wang
| | - Liang Gao
- School of Clinical Medicine, Nanjing Medical University, Nanjing, China
- Correspondence: Liang Gao Ke Wang
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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: 0.5] [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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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: 33] [Impact Index Per Article: 11.0] [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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Kung WM, Wang YC, Tzeng IS, Chen YT, Lin MS. Simulating Expansion of the Intracranial Space to Accommodate Brain Swelling after Decompressive Craniectomy: Volumetric Quantification in a 3D CAD Skull Model with Contour Elevation. Brain Sci 2021; 11:brainsci11040428. [PMID: 33801754 PMCID: PMC8067154 DOI: 10.3390/brainsci11040428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Decompressive craniectomy (DC) can be used to augment intracranial space and halt brainstem compromise. However, a widely adopted recommendation for optimal surgical extent of the DC procedure is lacking. In the current study, we utilized three-dimensional (3D) computer-assisted design (CAD) skull models with defect contour elevation for quantitative assessment. Methods: DC was performed for 15 consecutive patients, and 3D CAD models of defective skulls with contour elevations (0-50 mm) were reconstructed using commercial software. Quantitative assessments were conducted in these CAD subjects to analyze the effects of volumetric augmentation when elevating the length of the contour and the skull defect size. The final positive results were mathematically verified using a computerized system for numerical integration with the rectangle method. Results: Defect areas of the skull CAD models ranged from 55.7-168.8 cm2, with a mean of 132.3 ± 29.7 cm2. As the contour was elevated outward for 6 mm or above, statistical significance was detected in the volume and the volume-increasing rate, when compared to the results obtained from the regular CAD model. The volume and the volume-increasing rate increased by 3.665 cm3, 0.285% (p < 0.001) per 1 mm of contour elevation), and 0.034% (p < 0.001) per 1 cm2 of increase of defect area, respectively. Moreover, a 1 mm elevation of the contour in Groups 2 (defect area 125-150 cm2) and 3 (defect area >150 cm2, as a proxy for an extremely large skull defect) was shown to augment the volume and the volume-increasing rate by 1.553 cm3, 0.101% (p < 0.001) and 1.126 cm3, 0.072% (p < 0.001), respectively, when compared to those in Group 1 (defect area <125 cm2). The volumetric augmentation achieved by contour elevation for an extremely large skull defect was smaller than that achieved for a large skull defect. Conclusions: The 3D CAD skull model contour elevation method can be effectively used to simulate the extent of a space-occupying swollen brain and to quantitatively assess the extent of brainstem protection in terms of volume augmentation and volume-increasing rate following DC. As the tangential diameter (representing the degree of DC) exceeded the plateau value, volumetric augmentation was attenuated. However, an increasing volumetric augmentation was detected before the plateau value was reached.
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Affiliation(s)
- Woon-Man Kung
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan; (W.-M.K.); (I.-S.T.)
| | - Yao-Chin Wang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Emergency, Min-Sheng General Hospital, Taoyuan 33044, Taiwan
| | - I-Shiang Tzeng
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan; (W.-M.K.); (I.-S.T.)
| | - Yu-Te Chen
- Institute of Applied Mathematics, College of Science, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Muh-Shi Lin
- Division of Neurosurgery, Department of Surgery, Kuang Tien General Hospital, Taichung 43303, Taiwan
- Department of Biotechnology and Animal Science, College of Bioresources, National Ilan University, Yilan 26047, Taiwan
- Department of Biotechnology, College of Medical and Health Care, Hung Kuang University, Taichung 43302, Taiwan
- Department of Health Business Administration, College of Medical and Health Care, Hung Kuang University, Taichung 43302, Taiwan
- Correspondence: ; Tel.: +886-4-2665-1900
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Basu B, Bhaskar N, Barui S, Sharma V, Das S, Govindarajan N, Hegde P, Perikal PJ, Antharasanahalli Shivakumar M, Khanapure K, Tekkatte Jagannatha A. Evaluation of implant properties, safety profile and clinical efficacy of patient-specific acrylic prosthesis in cranioplasty using 3D binderjet printed cranium model: A pilot study. J Clin Neurosci 2021; 85:132-142. [PMID: 33581784 DOI: 10.1016/j.jocn.2020.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/14/2020] [Indexed: 01/21/2023]
Abstract
There exists a significant demand to develop patient-specific prosthesis in reconstruction of cranial vaults after decompressive craniectomy. we report here, the outcomes of an unicentric pilot study on acrylic cranial prosthesis fabricated using a 3D printed cranium model with its clinically relevant mechanical properties. METHODS The semi-crystalline polymethyl methacrylate (PMMA) implants, shaped to the cranial defects of 3D printed cranium model, were implanted in 10 patients (mean age, 40.8 ± 14.8 years). A binderjet 3D printer was used to create patient-specific mould and PMMA was casted to fabricate prosthesis which was analyzed for microstructure and properties. Patients were followed up for allergy, infection and cosmesis for a period of 6 months. RESULTS As-cast PMMA flap exhibited hardness of 15.8 ± 0.24Hv, tensile strength of 30.7 ± 3.9 MPa and elastic modulus of 1.5 ± 0.1 GPa. 3D microstructure of the semi-crystalline acrylic implant revealed 2.5-15 µm spherical isolated pores. The mean area of the calvarial defect in craniectomy patients was 94.7 ± 17.4 cm2. We achieved a cranial index of symmetry (CIS -%) of 94.5 ± 3.9, while the average post-operative Glasgow outcome scale (GOS) score recorded was 4.2 ± 0.9. CONCLUSIONS 3D printing based patient-specific design and fabrication of acrylic cranioplasty implant is safe and achieves acceptable cosmetic and clinical outcomes in patients with decompressive craniectomy. Our study ensured clinically acceptable structural and mechanical properties of implanted PMMA, suggesting that a low cost 3D printer based PMMA flap is an affordable option for cranioplasty in resource constrained settings.
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Affiliation(s)
- Bikramjit Basu
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India; Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India
| | - Nitu Bhaskar
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Srimanta Barui
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Vidushi Sharma
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Soumitra Das
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Nikhil Govindarajan
- Department of Metallurgical and Materials Engineering, National Institute of Technology, Surathkal, Mangaluru 575025, Karnataka, India
| | - Pranoy Hegde
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka 560054, India
| | - Parichay J Perikal
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka 560054, India
| | | | - Kiran Khanapure
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka 560054, India
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Kung WM, Tzeng IS, Lin MS. Three-Dimensional CAD in Skull Reconstruction: A Narrative Review with Focus on Cranioplasty and Its Potential Relevance to Brain Sciences. APPLIED SCIENCES-BASEL 2020. [DOI: https://doi.org/10.3390/app10051847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In patients suffering from severe traumatic brain injury and massive stroke (hemorrhagic or ischemic), decompressive craniectomy (DC) is a surgical strategy used to reduce intracranial pressure, and to prevent brainstem compromise from subsequent brain edema. In surviving patients, cranioplasty surgery helps to protect brain tissue, and correct the external deformity. The aesthetic outcome of cranioplasty using an asymmetrical implant can negatively influence patients physically and mentally, especially young patients. Advancements in the development of biomaterials have now made three-dimensional (3-D) computer-assisted design/manufacturing (CAD/CAM)-fabricated implants an optimal choice for the repair of skull defects following DC. Here, we summarize the various materials for cranioplasty, including xenogeneic, autogenous, and alloplastic grafts. The processing procedures of the CAD/CAM technique are briefly outlined, and reflected our experiences to reconstruct skull CAD models using commercial software, published previously, to assess aesthetic outcomes of regular 3-D CAD models without contouring elevation or depression. The establishment of a 3-D CAD model ensures a possibility for better aesthetic outcomes of CAM-derived alloplastic implants. Finally, clinical consideration of the CAD algorithms for adjusting contours and their potential application in prospective healthcare are briefly outlined.
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Three-Dimensional CAD in Skull Reconstruction: A Narrative Review with Focus on Cranioplasty and Its Potential Relevance to Brain Sciences. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10051847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In patients suffering from severe traumatic brain injury and massive stroke (hemorrhagic or ischemic), decompressive craniectomy (DC) is a surgical strategy used to reduce intracranial pressure, and to prevent brainstem compromise from subsequent brain edema. In surviving patients, cranioplasty surgery helps to protect brain tissue, and correct the external deformity. The aesthetic outcome of cranioplasty using an asymmetrical implant can negatively influence patients physically and mentally, especially young patients. Advancements in the development of biomaterials have now made three-dimensional (3-D) computer-assisted design/manufacturing (CAD/CAM)-fabricated implants an optimal choice for the repair of skull defects following DC. Here, we summarize the various materials for cranioplasty, including xenogeneic, autogenous, and alloplastic grafts. The processing procedures of the CAD/CAM technique are briefly outlined, and reflected our experiences to reconstruct skull CAD models using commercial software, published previously, to assess aesthetic outcomes of regular 3-D CAD models without contouring elevation or depression. The establishment of a 3-D CAD model ensures a possibility for better aesthetic outcomes of CAM-derived alloplastic implants. Finally, clinical consideration of the CAD algorithms for adjusting contours and their potential application in prospective healthcare are briefly outlined.
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Peel S, Eggbeer D, Burton H, Hanson H, Evans PL. Additively manufactured versus conventionally pressed cranioplasty implants: An accuracy comparison. Proc Inst Mech Eng H 2018; 232:949-961. [DOI: 10.1177/0954411918794718] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article compared the accuracy of producing patient-specific cranioplasty implants using four different approaches. Benchmark geometry was designed to represent a cranium and a defect added simulating a craniectomy. An ‘ideal’ contour reconstruction was calculated and compared against reconstructions resulting from the four approaches –‘conventional’, ‘semi-digital’, ‘digital – non-automated’ and ‘digital – semi-automated’. The ‘conventional’ approach relied on hand carving a reconstruction, turning this into a press tool, and pressing titanium sheet. This approach is common in the UK National Health Service. The ‘semi-digital’ approach removed the hand-carving element. Both of the ‘digital’ approaches utilised additive manufacturing to produce the end-use implant. The geometries were designed using a non-specialised computer-aided design software and a semi-automated cranioplasty implant-specific computer-aided design software. It was found that all plates were clinically acceptable and that the digitally designed and additive manufacturing plates were as accurate as the conventional implants. There were no significant differences between the additive manufacturing plates designed using non-specialised computer-aided design software and those designed using the semi-automated tool. The semi-automated software and additive manufacturing production process were capable of producing cranioplasty implants of similar accuracy to multi-purpose software and additive manufacturing, and both were more accurate than handmade implants. The difference was not of clinical significance, demonstrating that the accuracy of additive manufacturing cranioplasty implants meets current best practice.
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Affiliation(s)
- Sean Peel
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Dominic Eggbeer
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Hanna Burton
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Hayley Hanson
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Peter L Evans
- Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
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Plastic Surgery Applications Using Three-Dimensional Planning and Computer-Assisted Design and Manufacturing. Plast Reconstr Surg 2016; 137:603e-616e. [DOI: 10.1097/01.prs.0000479970.22181.53] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ciporen J, Lucke-Wold BP, Mendez G, Chen A, Banerjee A, Akins PT, Balough BJ. Single-staged resections and 3D reconstructions of the nasion, glabella, medial orbital wall, and frontal sinus and bone: Long-term outcome and review of the literature. Surg Neurol Int 2016; 7:S1107-S1112. [PMID: 28194296 PMCID: PMC5299155 DOI: 10.4103/2152-7806.196773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/10/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Aesthetic facial appearance following neurosurgical ablation of frontal fossa tumors is a primary concern for patients and neurosurgeons alike. Craniofacial reconstruction procedures have drastically evolved since the development of three-dimensional computed tomography imaging and computer-assisted programming. Traditionally, two-stage approaches for resection and reconstruction were used; however, these two-stage approaches have many complications including cerebrospinal fluid leaks, necrosis, and pneumocephalus. CASE DESCRIPTION We present two successful cases of single-stage osteoma resection and craniofacial reconstruction in a 26-year-old female and 65-year-old male. The biopolymer implants were preselected and contoured based on imaging prior to surgery. The ideal selection of appropriate flaps for reconstruction was imperative. The flaps were well vascularized and included a pedicle for easy translocation. Using a titanium mesh biopolymer implant for reconstruction in conjunction with a forehead flap proved advantageous, and the benefits of single-stage approaches were apparent. The patients recovered quickly after the surgery with complete resection of the osteoma and good aesthetic appearance. The flap adhered to the biopolymer implant, and the cosmetic appearance years after surgery remained decent. The gap between the bone and implant was less than 2 mm. The patients are highly satisfied with the symmetrical appearance of the reconstruction. CONCLUSIONS Advances in technology are allowing neurosurgeons unprecedented opportunities to design complex yet feasible single-stage craniofacial reconstructions that improve a patient's quality of life by enhancing facial contours, aesthetics, and symmetry.
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Affiliation(s)
- Jeremy Ciporen
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
- Corresponding author
| | - Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Gustavo Mendez
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Anton Chen
- Department of ENT, Kaiser Permanente, Sacramento, California, USA
| | - Amit Banerjee
- Department of Neurosurgery, Kaiser Permanente, Sacramento, California, USA
| | - Paul T. Akins
- Department of Neurosurgery, Kaiser Permanente, Sacramento, California, USA
| | - Ben J. Balough
- Department of ENT, Kaiser Permanente, Sacramento, California, USA
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Tan ETW, Ling JM, Dinesh SK. The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer. J Neurosurg 2015; 124:1531-7. [PMID: 26566203 DOI: 10.3171/2015.5.jns15119] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Commercially available, preformed patient-specific cranioplasty implants are anatomically accurate but costly. Acrylic bone cement is a commonly used alternative. However, the manual shaping of the bone cement is difficult and may not lead to a satisfactory implant in some cases. The object of this study was to determine the feasibility of fabricating molds using a commercial low-cost 3D printer for the purpose of producing patient-specific acrylic cranioplasty implants. METHODS Using data from a high-resolution brain CT scan of a patient with a calvarial defect posthemicraniectomy, a skull phantom and a mold were generated with computer software and fabricated with the 3D printer using the fused deposition modeling method. The mold was used as a template to shape the acrylic implant, which was formed via a polymerization reaction. The resulting implant was fitted to the skull phantom and the cranial index of symmetry was determined. RESULTS The skull phantom and mold were successfully fabricated with the 3D printer. The application of acrylic bone cement to the mold was simple and straightforward. The resulting implant did not require further adjustment or drilling prior to being fitted to the skull phantom. The cranial index of symmetry was 96.2% (the cranial index of symmetry is 100% for a perfectly symmetrical skull). CONCLUSIONS This study showed that it is feasible to produce patient-specific acrylic cranioplasty implants with a low-cost 3D printer. Further studies are required to determine applicability in the clinical setting. This promising technique has the potential to bring personalized medicine to more patients around the world.
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Affiliation(s)
- Eddie T W Tan
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Ji Min Ling
- Department of Neurosurgery, National Neuroscience Institute, Singapore
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