Cranioplasty Using Presurgically Fabricated Presterilised Polymethyl Methacrylate Plate by a Simple, Cost-Effective Technique on Patients With and Without Original Bone Flap: Study on 29 Patients

Sharavanan, G. M.; Jayabalan, Suresh; Rajasukumaran, K.; Veerasekar, Ganesh; Sathya, G.

doi:10.1007/s12663-014-0670-4

Cited by 13 publications

(11 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18 Advantages of computer-designed, prefabricated implants have been demonstrated and include improved cosmetic outcome as well as minimization of the procedure time needed for implant insertion. 16 However, in most series, expensive commercial and industrial 3D printers (approximately US$37,000-US$310,000) or expensive com-mercial implants (approximately US$10,000) 3,5,8,13,18,21,22,26,[30][31][32] were used, which are prohibitive for use in low-and middle-income countries.…”

Section: Discussionmentioning

confidence: 99%

“…Different techniques have been reported for customizing a cost-effective implant, with most using the head of the patient prior to or during the surgery and casting. 2,5,7,9,19,20,30,31,33 However, despite their low associated cost, these techniques are not precise or reliable, the original bone flap is needed, and the procedure involves many time-consuming steps. Recently, Abdel Hay et al published 2 cases in which a template of the external surface was used to mold the implant by hand.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Morales-Gómez¹,

Garcia-Estrada²,

Leos-Bortoni³

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE Cranioplasty implants should be widely available, low in cost, and customized or easy to mold during surgery. Although autologous bone remains the first choice for repair, it cannot always be used due to infection, fragmentation, bone resorption, or other causes, which led to use of synthetic alternatives. The most frequently used allogenic material for cranial reconstructions with long-term results is polymethylmethacrylate (PMMA). Three-dimensional printing technology has allowed the production of increasingly popular customized, prefabricated implants. The authors describe their method and experience with a customized PMMA prosthesis using a precise and reliable low-cost implant that can be customized at any institution with open-source or low-cost software and desktop 3D printers. METHODS A review of 22 consecutive patients undergoing CT-based, low-cost, customized PMMA cranioplasty over a 1-year period at a university teaching hospital was performed. Preoperative data included patient sex and age; CT modeling parameters, including the surface area of the implant (defect); reason for craniectomy; date(s) of injury and/or resections; the complexity of the defect; and associated comorbidities. Postoperative data included morbiditiy and complications, such as implant exposure, infection, hematoma, seroma, implant failure, and seizures; the cost of the implant; and cosmetic outcome. RESULTS Indications for the primary craniectomy were traumatic brain injury (16, 73%), tumor resection (3, 14%), infection (1, 4%), and vascular (2, 9%). The median interval between previous surgery and PMMA cranioplasty was 12 months. The operation time ranged from 90 to 150 minutes (mean 126 minutes). The average cranial defect measured 65.16 cm (range 29.31-131.06 cm). During the recovery period, there was no sign of infection, implant rejection, or wound dehiscence, and none of the implants had to be removed over a follow-up ranging from 1 to 6 months. The aesthetic appearance of all patients was significantly improved, and the implant fit was excellent. CONCLUSIONS The use of a customized PMMA was associated with excellent patient, family, and surgeon satisfaction at follow-up at a fraction of the cost associated with commercially available implants. This technique could be an attractive option to all patients undergoing cranioplasty.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Morales-Gómez¹,

Garcia-Estrada²,

Leos-Bortoni³

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…However, there is the potential for several complications, including hardware malfunction, infection, migration, and protrusion 36 . Migration and protrusion have been particularly implicated in PCH because of local inflammation, soft tissue erosion, and irritation of nociceptors 20,21,37,38 . Patients often experience pain exacerbated by palpation directly above the hardware with possible visible thinning and atrophy of their overlying scalp tissue 21 .…”

Section: Discussionmentioning

confidence: 99%

“…36 Migration and protrusion have been particularly implicated in PCH because of local inflammation, soft tissue erosion, and irritation of nociceptors. 20,21,37,38 Patients often experience pain exacerbated by palpation directly above the hardware with possible visible thinning and atrophy of their overlying scalp tissue. 21 A recent study reported an incidence of hardware removal secondary to pain and protrusion as low as 1.6%.…”

Section: Hardwarementioning

confidence: 99%

Expanding Our Role in Headache Management

et al. 2023

View full text Add to dashboard Cite

Background Chronic postcraniotomy headache (PCH) is common and debilitating. Unfortunately, the literature on this topic is sparse without clear management algorithms. Possible etiologies of PCH include nerve injury and/or entrapment, hardware, dural adhesions, or musculoskeletal injury. The purpose of this study was to present the results of both a systematic review of the literature and a single-center case series, both of which informed the development of a novel treatment algorithm that may be applied to this patient population Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed a systematic review of the literature, identifying articles describing the surgical management of PCH. A retrospective chart review was performed to identify patients who met the criteria for PCH treated at our institution. A patient's history and physical examination determined the etiology and management, and pain severity scores were the primary outcome measured. Results Nineteen articles encompassing 131 patients described surgical management techniques for PCH. 83 patients (63.3%) had complete resolution of pain (χ 2 = 52.1, P < 0.0001). At our institution, 19 patients underwent surgical management for PCH. A significant reduction in pain scores from 7.57 to 2.16 (P < 0.001) was demonstrated, and 84 percent of patients achieved complete or significant pain reduction. Conclusions Through a literature review and our own case series, we demonstrate that surgical management of PCH can achieve remarkable results. Plastic surgeons, with their expanding role in treating migraine and headaches, are well suited to manage these patients. We present an algorithmic approach to simplify the management of this common and debilitating condition.

show abstract

“…PEEK or titanium 3D printers can cost from US$37,000 to US$310,000, and prefabricated implants can cost up to US$10,000. [ 3 , 5 , 6 , 9 , 11 , 15 , 16 , 18 , 20 - 22 ] Price is perhaps the most important consideration in an LMIC setting such as ours, where median monthly income is approximately US$500. PMMA is an attractive option given the minimum price.…”

Section: Discussionmentioning

confidence: 99%

Early experience with patient-specific low-cost 3D-printed polymethylmethacrylate cranioplasty implants in a lower-middle-income-country: Technical note and economic analysis

Ashraf

Choudhary

Kamboh

et al. 2022

Surgical Neurology International

View full text Add to dashboard Cite

Background: Polymethyl methacrylate (PMMA) cranioplasty, while widely prevalent, has limitations associated with freehand manual intraoperative molding. PMMA has been superseded by titanium or Polyetheretherketone implants, prefabricated commercially from preoperative CT scans, and boasting superior clinical and cosmetic outcomes. However, such services are extremely inaccessible and unaffordable in the lower-middle-income country (LMIC) settings. The study aims to describe, in detail, the process of making ultra-low-cost patient-specific PMMA cranioplasty implants with minimum resources using open-access software. We report the first such service from the public health-care system within Pakistan, a LMIC. Methods: Using open-source software, preoperative CT heads were used to prefabricate three-dimensional implants. Both implant and cranial defects were printed using polylactic acid (PLA) to assess the implant’s size and fit preoperatively. From the PLA implant, we fashioned a silicon mold that shapes the PMMA implant. Ten patients who underwent cranioplasty using our technique for various cranial defects with at least a 12-month follow-up were retrospectively reviewed. Clinical, cosmetic, and radiological outcomes were objectively assessed. Results: Etiology of injury was trauma (8), malignant MCA infarct (1), and arteriovenous fistula (1). We produced seven frontotemporal-parietal implants, one bifrontal, one frontal, and one frontoparietal. At 1 year, eight patients reported their cosmetic appearance comparable to before the defect. Radiological outcome was classified as “excellent” for eight patients. No postoperative complications were encountered, nor did any implant have to be removed. One patient’s implant involving the orbital ridge had an unsatisfactory cosmetic outcome and required revision surgery. The average cost per implant to the National Health Service was US$40. Conclusion: Prefabricated patient-specific PMMA cranioplasty implants are cost-effective. A single surgeon can fashion them in a limited resource setting and provide personalized medicine with excellent clinical/cosmetic-radiological results. Our method produces patient-specific cranioplasty implants in an otherwise unaffordable LMIC setting.

show abstract

Cranioplasty Using Presurgically Fabricated Presterilised Polymethyl Methacrylate Plate by a Simple, Cost-Effective Technique on Patients With and Without Original Bone Flap: Study on 29 Patients

Cited by 13 publications

References 7 publications

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Expanding Our Role in Headache Management

Early experience with patient-specific low-cost 3D-printed polymethylmethacrylate cranioplasty implants in a lower-middle-income-country: Technical note and economic analysis

Contact Info

Product

Resources

About