Cranioplasty with Individual Carbon Fibre Reinforced Polymere (CFRP) Medical Grade Implants Based on CAD/CAM Technique

Saringer, Walter; Nöbauer-Huhmann, Iris; Knosp, Engelbert

doi:10.1007/s00701-002-0995-5

Cited by 69 publications

(52 citation statements)

References 22 publications

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“…3 In a series of 29 patients, not a single CFRP plate had to be removed. 39 The CAD/CAM PEEK implants for cranioplasty are gaining access in calvarial reconstruction, 42 but larger case studies have not yet been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Computer-assisted design and modeling of cranioplastic materials has improved the cosmetic outcome as well as minimized the procedure time needed for plate insertion. 7,21,39 Numerous materials have shown high biocompatibility and clinical reliability, 32 such as PMMA, titanium, numerous ceramics such as HA, carbon materials such as CFRP, and others (Table Long-term results following titanium cranioplasty of large skull defects 1). Nevertheless, it is unclear which material provides the best overall result.…”

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confidence: 99%

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Long-term results following titanium cranioplasty of large skull defects

Čabraja¹,

Klein

Lehmann³

2009

FOC

263

171

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Object Decompressive craniectomy is an established procedure to lower intracranial pressure. Therefore, cranioplasty remains a necessity in neurosurgery as well. If the patient's own bone flap is not available, the surgeon can choose between various alloplast grafts. A review of the literature proves that 4–13.8% of polymethylmethacrylate plates and 2.6–10% of hydroxyapatite-based implants require replacement. In this retrospective study of large skull defects, the authors compared computer-assisted design/computer-assisted modeled (CAD/CAM) titanium implants for cranioplasty with other frequently used materials described in literature. Methods Twenty-six patients underwent cranioplasty with CAD/CAM titanium implants (mean diameter 112 mm). With the aid of visual analog scales, the patients' pain and cosmesis were evaluated 6–12 years (mean 8.1 years) after insertion of the implants. Results None of the implants had to be removed. Of all patients, 68% declared their outcomes as excellent, 24% as good, 0.8% as fair, and 0% as poor. There was no resulting pain in 84% of the patients, and 88% were satisfied with the cosmetic result, noting > 75 mm on the visual analog scale of cosmesis. All patients would have chosen cranioplasty again, stating an improvement in their quality of life by the calvarial reconstruction. Nevertheless, follow-up images obtained in 4 patients undergoing removal of meningiomas was only suboptimal. Conclusions With the aid of CAD technology, all currently used alloplastic materials are suited even for large skull defect cranioplasty. Analysis of the authors' data and the literature shows that cranioplasty with CAD/CAM titanium implants provides the lowest rate of complications, reasonable costs, and acceptable postoperative imaging. Polymethylmethacrylate is suited for primary cranioplasty or for long-term follow-up imaging of tumors. Titanium implants seem to be the material of choice for secondary cranioplasty of large skull defects resulting from decompressive craniectomy after trauma or infarction. Expensive HA-based ceramics show no obvious advantage over titanium or PMMA.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Long-term results following titanium cranioplasty of large skull defects

Čabraja¹,

Klein

Lehmann³

2009

FOC

263

171

View full text Add to dashboard Cite

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“…Numerous synthetic materials, such as titanium [32], polymethyl methacrylate (PMMA) [13,28], carbon [41], polyetheretherketone (PEEK) [2], hydroxyapatite (HA) [42], ceramics [27], and osteoconductive bioresorbable materials [8], have been applied to correct skull defects after permanent removal of the bone flap. PMMA is the most frequently used material to restore normal skull contour and shape [28,37].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty

et al. 2012

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Cranioplasty is a common neurosurgical procedure. Free-hand molding of polymethyl methacrylate (PMMA) cement into complex three-dimensional shapes is often time-consuming and may result in disappointing cosmetic outcomes. Computer-assisted patient-specific implants address these disadvantages but are associated with long production times and high costs. In this study, we evaluated the clinical, radiological, and cosmetic outcomes of a timesaving and inexpensive intraoperative method to mold custom-made implants for immediate single-stage or delayed cranioplasty. Data were collected from patients in whom cranioplasty became necessary after removal of bone flaps affected by intracranial infection, tumor invasion, or trauma. A PMMA replica was cast between a negative form of the patient's own bone flap and the original bone flap with exactly the same shape, thickness, and dimensions. Clinical and radiological follow-up was performed 2 months post-surgery. Patient satisfaction (Odom criteria) and cosmesis (visual analogue scale for cosmesis) were evaluated 1 to 3 years after cranioplasty. Twenty-seven patients underwent intraoperative template-molded patient-specific cranioplasty with PMMA. The indications for cranioplasty included bone flap infection (56%, n015), calvarian tumor resection (37%, n010), and defect after trauma (7%, n02). The mean duration of the molding procedure was 19±7 min. Excellent radiological implant alignment was achieved in 94% of the cases. All (n023) but one patient rated the cosmetic outcome (mean 1.4 years after cranioplasty) as excellent (70%, n016) or good (26%, n06). Intraoperative cast-molded reconstructive cranioplasty is a feasible, accurate, fast, and cost-efficient technique that results in excellent cosmetic outcomes, even with large and complex skull defects.Keywords Patient-specific implant . Cranioplasty . Skull bone flap . Bone replacement material polymethyl methacrylate-PMMA . Brain tumors . Trauma . Brain

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“…The old bone flap was removed as was the old generator, and a prefashioned polyetheretherketone cranioplasty was placed. The cranioplasty was fashioned with W. S. Anderson et al the help of computer-aided design from CT-derived data 13,25 (Synthes, Inc.). This implant was also designed to work in conjunction with the RNS ferrule.…”

Section: Casementioning

confidence: 99%

Implantation of a responsive neurostimulator device in patients with refractory epilepsy

Anderson

Kossoff²,

Bergey³

et al. 2008

FOC

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Object The authors summarize one center's experience with a novel device, the Responsive Neurostimulation (RNS) system, which is used to treat seizures, and they provide technical details regarding the implantation procedure. Methods The authors reviewed seizure detection, cortical stimulation, and clinical data obtained in 7 patients in whom the RNS system was implanted. Data pertaining to seizure alteration are provided for the first 4 implant-treated patients. The implantation procedure in the case of one patient with occipital lobe heterotopia is included. Results Based on patients' seizure diaries, the implanted devices functioned at a high sensitivity for clinical seizure detection. Reductions in seizure frequency, based on their diaries and on clinic follow-up notes, ranged from 50 to 75%. No adverse stimulation-induced side effects were noted, and no hardware malfunctions requiring explantation occurred. Generator replacements for battery depletion were required at 11, 17, and 20 months in 3 patients. The implantation procedure was well tolerated, and postoperative hospital stays were short. A revision cranioplasty for a skull defect was performed in the index patient, whose case will be discussed in the most detail. Conclusions The results obtained in this small preliminary series demonstrate a safe implantation method for the responsive neurostimulation device.

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Cranioplasty with Individual Carbon Fibre Reinforced Polymere (CFRP) Medical Grade Implants Based on CAD/CAM Technique

Cited by 69 publications

References 22 publications

Long-term results following titanium cranioplasty of large skull defects

Long-term results following titanium cranioplasty of large skull defects

Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty

Implantation of a responsive neurostimulator device in patients with refractory epilepsy

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