Cranioplasty

Stula, D

doi:10.1007/978-3-7091-8762-3

Cited by 9 publications

(5 citation statements)

References 65 publications

(138 reference statements)

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“…The history of cranioplasty is an interesting one, [4][5][6][7][8] in which a multitude of materials ranging from the logical (autologous split thickness calvarium, 9 allografts, and even xenografts 7 ) to the bizarre (coconut shells 8 ) have been tried to replace lost calvarium. Currently, PMMA, titanium and, most recently, PEEK are being used with varying degrees of success.…”

Section: Discussionmentioning

confidence: 99%

Designer Cranioplasty at Budget Prices: A Novel Use of 3D Printing Technology

Yerragunta

Kanala

Yerramneni

et al. 2021

Indian Journal of Neurosurgery

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Background Cranioplasty using synthetic materials for restoration of the exact shape of the skull has always remained a challenge until the development of 3D printing technology. However, the high-cost of available 3D printed implants limits their extensive use. Objectives To study the effectiveness of a low-cost, 3D-printed template for molding the polymethyl methacrylate (PMMA) (bone cement) in order to achieve exact contours of the skull specific to each patient. Materials and Methods 10 cranioplasties have been performed between July 2018 to December 2019 in a variety of craniotomy defects using bone cement flaps shaped using custom-made molds. The mold was 3D-printed and based on each patient’s CT images in digital imaging and communications in medicine (DICOM). Miniplates and screws were used to fix the flap. Postoperatively, clinical and radiological evaluation were done to assess patient satisfaction and accuracy of contour achieved. Results Patient satisfaction as well as accuracy of contouring, as seen on postoperative CT scans, were excellent. There were no notable complications on follow-up. Conclusion PMMA cranioplasty flap, contoured using a 3D-printed mold, is a very cost-effective alternative for restoration of skull contour for various craniotomy defects.Polymethyl methacrylate (PMMA) molded to form the exact shape of lost calvarium using 3D printed plastic templates is a smart and economical solution

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Section: Discussionmentioning

confidence: 99%

Designer Cranioplasty at Budget Prices: A Novel Use of 3D Printing Technology

Yerragunta

Kanala

Yerramneni

et al. 2021

Indian Journal of Neurosurgery

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“…Stula[6] argues that his own rate of post-cranioplasty infection was 14%, among 51 patients submitted to cranial reconstruction with PMMA. This incidence decreased to 8.5% when he started adding antibiotics to his cranial PMMA reconstructions.…”

Section: Discussionmentioning

confidence: 99%

Polymethylmethacrylate imbedded with antibiotics cranioplasty: An infection solution for moderate and large defects reconstruction

Worm¹,

Nascimento

Nicola

et al. 2016

Surg Neurol Int

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Background:In cases where autologous bone graft reconstruction is not possible (such as comminuted fractures, bone graft reabsorption, or infection) and the use of synthetic material is required, polymethylmethacrylate (PMMA) use is a safe and efficient solution. Studies comparing the incidence of postoperative complications between autologous and synthetic cranioplasty are heterogeneous, not allowing a conclusion of which is the best material for skull defects reconstruction. Current medical literature lacks prospective well-delineated studies with long-term follow-up that analyze the impact of antibiotic use in PMMA cranial reconstruction of moderate and large defects.Methods:A prospective series of patients, who underwent cranioplasty reconstruction with PMMA impregnated with antibiotic, were followed for 2 years. Authors collected data regarding demographic status, clinical conditions, surgical information, and its complications.Results:A total of 58 patients completed full follow-up with a mean group age of 40 years and a male predominance (77%). Major complications that required surgical management were identified in 5 patients, and 10 patients evolved with minor complications. Postoperative surgical site infection incidence was 3.2%.Conclusion:The infection rate in patients submitted to PMMA flap cranioplasty impregnated with antibiotic is significantly inferior comparing to the data described in medical literature. A lower infection incidence impacts secondary endpoints such as minimizing surgical morbidity, mortality, hospitalization period, and, consequently, costs.

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“…Cranial bone defects can be classified as congenital or acquired, depending on their origin. The acquired defects can be caused by a traumatic injury (being the most common cause), cranial bone tumors originated in the skull bone (primary tumors) or in the neighboring (secondary tumors), osteomyelitis (bone infection) or a cranial bone resorption (Stula, 1984). A surgical procedure, cranioplasty, is used to remove and substitute the damaged area of the skull bone using a cranial implant.…”

Section: Introductionmentioning

confidence: 99%

Customized cranial implant manufactured by incremental sheet forming using a biocompatible polymer

Bagudanch

García-Romeu

Ferrer

et al. 2018

RPJ

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Purpose The purpose of this paper is to demonstrate the feasibility of incremental sheet forming (ISF), using the most common variants, single-point incremental forming (SPIF) and two-point incremental forming (TPIF), to produce prototypes of customized cranial implants using a biocompatible polymer (ultrahigh molecular weight polyethylene, UHMWPE), ensuring an appropriate geometric accuracy and cost. Design/methodology/approach The cranial implant is designed based on computerized tomographies (CT) of the patient, converting them into a 3D model using the software InVesalius. To generate the toolpath for the forming operation computer-aided manufacturing (CAM) software is used. Once the cranial implant is manufactured, a 3D scanning system is used to determine the geometric deviation between the real part and the initial design. Findings The results corroborate that it is possible to successfully manufacture a customized cranial implant using ISF, being able to improve the geometric accuracy using the TPIF variant with a negative die. Originality/value This paper is one of the first research works in which a customized cranial implant is successfully manufactured using a flexible technology, ISF and a biocompatible polymer. The use of polymeric implants in cranioplasty is advantageous because of their lightweight, low heat conductivity and mechanical properties similar to bone. Furthermore, the cost of the implant has been calculated considering not only the raw materials and manufacturing time but also the environmental impact, revealing that it is a cheap process with a low lead-time.

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Cranioplasty

Cited by 9 publications

References 65 publications

Designer Cranioplasty at Budget Prices: A Novel Use of 3D Printing Technology

Designer Cranioplasty at Budget Prices: A Novel Use of 3D Printing Technology

Polymethylmethacrylate imbedded with antibiotics cranioplasty: An infection solution for moderate and large defects reconstruction

Customized cranial implant manufactured by incremental sheet forming using a biocompatible polymer

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