Bespoke Implants for Cranial Reconstructions: Preoperative to Postoperative Surgery Management System

Abstract

Traumatic brain injury is a leading cause of death and disability worldwide, with nearly 90% of the deaths coming from low- and middle-income countries. Severe cases of brain injury often require a craniectomy, succeeded by cranioplasty surgery to restore the integrity of the skull for both cerebral protection and cosmetic purposes. The current paper proposes a study on developing and implementing an integrative surgery management system for cranial reconstructions using bespoke implants as an accessible and cost-effective solution. Bespoke cranial implants were designed for three patients and subsequent cranioplasties were performed. Overall dimensional accuracy was evaluated on all three axes and surface roughness was measured with a minimum value of 2.209 μm for Ra on the convex and concave surfaces of the 3D-printed prototype implants. Improvements in patient compliance and quality of life were reported in postoperative evaluations of all patients involved in the study. No complications were registered from both short-term and long-term monitoring. Material and processing costs were lower compared to a metal 3D-printed implants through the usage of readily available tools and materials, such as standardized and regulated bone cement materials, for the manufacturing of the final bespoke cranial implants. Intraoperative times were reduced through the pre-planning management stages, leading to a better implant fit and overall patient satisfaction.

Finite Element Analysis of Patient-Specific Cranial Implants under Different Design Parameters for Material Selection

“…However, they diverge in mechanical properties and costs, with PMMA being approximately 55% more economical than PEEK (USD 2702 vs. USD 4684, approximate value for an implant in Colombia without osteosynthesis material). In [25], the authors proposed an integrative surgery management system for cranial reconstructions using patient-specific implants made of PMMA as an accessible and cost-effective solution for low-income countries. This cost differential underscores a significant economic consideration in choosing between the two materials for neurosurgical implants while maintaining comparable clinical effectiveness and patient satisfaction.…”