Drilling template application could contribute to challenging cases of large fronto-basal meningiomas with the aim of minimizing operation time and achieving a good esthetic outcome.
The preoperative manufacturing of individual skull implants, developed by an interdisciplinary research group at Ruhr-University Bochum, is based on the use of titanium as the most common material for implants at present. Using the existing technology for materials that can be milled or moulded, customized implants may be manufactured as well. The goal of the study was to examine biodegradable materials and to evaluate the practicability of intraoperative instrument navigation and robotics. Data acquisition of an adult sheep's head was performed with helical computer tomography (CT). The data were transferred onto a computer aided design/computer aided manufacturing system (CAD/CAM system), and two complex defects in the frontotemporal skull were designed. Standard individual titanium implants were milled for both of the defects. Additionally, for one of the defects a resection template, as well as a mould for the biodegradable poly(D,L-lactide) (PDLLA) implant, were fabricated by the CAD/CAM system. A surgeon carried out the first bone resection (#1) for the prefabricated titanium implant using the resection template and an oscillating saw. The robot system Stäubli RX90CR, modified for clinical use, carried out the other resection (#2). Both titanium implants and the PDLLA implant were inserted in their respective defects to compare the precision of their fit. A critical comparison of both implant materials and both resection types shows that fabrication of a PDLLA implant and robot resection are already possible. At present, the titanium implant and resection using a template are more convincing due to the higher precision and practicability.
Objective The TICC (Tomography, Image processing, CAD, CAM) processing chain developed at the RuhrUniversity Bochum in Germany has already been established since several years for the reconstruction of large pre-existing posttraumatic skull defects with individual prefabricated implants made of pure titanium. So far, more than 500 titanium implants have been inserted with great success at more than 60 clinical centres worldwide. The aim of our study was to evaluate all implants inserted between 1994 and 2000.
Materials and MethodsThe study describes the clinical experience with 166 patients receiving 169 skull implants between 1994 and 2000. All 169 implants were measured and categorized in the CAD system in terms of size and anatomical localization. The surgical and radiological reports of the patients were evaluated. Sixty patients operated at the university hospital in Bochum and nearby were clinically reviewed describing scars, position of the implants and cosmetic results.Questionnaires of 131 patients were analyzed regarding the postoperative quality of life distinctly. Results The study shows constantly good to excellent results intraoperatively as well as postoperatively regarding complications, fit of the implants and the clinical follow-up. In particular the enquiry of the patients shows that titanium skull implants improve quality of life. Conclusion High precision and easy handling as well as a low complication rate and the high contentedness of the patients make the individual titanium skull implants valuable for cranioplasty, especially in complicated applications with very large defects, multiple previous operations and additional irradiations. Even in these difficult cases predictable results are possible.
The use of titanium fulfils the highest demands of biocompatibility while at the same time allowing the possibility of an oncological examination using suitable turbo-spinecho-sequences in MRI.
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