Cranioplasty with three-dimensional customised mould for polymethylmethacrylate implant: a series of 16 consecutive patients with cost-effectiveness consideration

Abstract

Background Different methods of cranioplasty for the reconstruction of bony skull defects exist. In the absence of the autologous bone flap, a customised manufactured implant may be the optimal choice, but this implant has several limitations regarding its technical standardisation and better cost-effectiveness. Methods This study presents a series of 16 consecutive patients who had undergone cranioplasty with customised three-dimensional (3D) template moulds for polymethylmethacrylate (PMMA) implants manufactured after 3D modelling on a specific workstation. The virtual images were transformed into a two-piece physical model using a 3D printer for the biomaterials. PMMA implant was produced intraoperatively with the custom mould. Cosmetic results were analysed by comparing pre- and postoperative 3D computed tomography (CT) images and asking if the patient was satisfied with the result. Results The average total time for planning and production of customised mould was 10 days. The 16 patients were satisfied with the result, and CT images presented harmonious symmetry when comparing pre- and postoperative scans. Cases of postoperative infection, bleeding, or reoperation in this series were not observed. Conclusion Cranioplasty with high-technology customised 3D moulds for PMMA implants can allow for an aesthetic reconstruction with a fast and cost-effective manufacturing process and possibly with low complication rates.

Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants

“…There have been several reports on applying point-of-care (POC) 3D printing in numerous avenues, including the fabrication of anatomical biomodels for preoperative surgical planning, surgical guides, and prosthetic aids [18,19]. Particularly in the context of cranioplasty, recently published reports have demonstrated the fabrication of customized acrylic cranioplasty implants in hospitals assisted by 3D-printed molds [20][21][22][23]. However, very few reports have addressed the avenue of POC manufacturing of 3D-printed personalized implants.…”

Customized polymethylmethacrylate cranioplasty using a low-cost 3-dimensional printed mold

“…Characteristics expected to meet are biocompatibility, inertness, radiolucency, rigidity, but the material should also be light, non-magnetic, simple for handling and placement, and with low thermal conductivity [7,8,9]. Currently, most used alloplastic materials encompass metals, acrylic materials, plastics, and hydroxyapatite (H.A.)…”

“…Further differences concern the method of obtaining the final prosthesis. Although printing a prosthesis model, followed by making a plaster cast and additional molding of PMMA final graft is possible, we find it unnecessary and too complicated since it can result in significant mold and prosthesis deformation [7,9]. Using one-side mold achieves precise curvature but makes it almost impossible to achieve the exact volume of graft, fill the trephine wholes, and bares risks of the uneven and bumpy inner side of the graft [1,10].…”

“…Although technically undemanding, skull reconstruction still carries risks of early and late postoperative complications [4,5,9,10]. The overall rate of complication differs, usually raging 5-25% [9,13]. We would like to emphasize, in particular early postoperative care, including mandatory CT scan.…”

“…Besides excellent esthetic outcome, shorter operation time, lower blood loss and infection rate, without donor site morbidity, using printed customized molds offers the possibility of intraoperative correction and remanufacturing of the graft in case of infection or prosthesis fracture [9,14,15]. The total price of graft manufacturing is below 600$, making it lower than the prices stated in the literature, ranging 600-5000$.…”