Customized cost-effective polymethylmethacrylate cranioplasty: a cosmetic comparison with other low-cost methods of cranioplasty

Baldia, Manish; Joseph, Mathew; Sharma, Suryaprakash; Kumar, Dinesh; Retnam, Ashwin; Koshy, Santosh; Karuppusami, Reka

doi:10.1007/s00701-022-05121-0

Cited by 7 publications

(8 citation statements)

References 38 publications

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“…Especially for large frontotemporoparietal defects or defects involving the orbit, which have complex geometry, we were able to show that with the 3D printer-assisted technique, and a satisfactory cosmetic result could be achieved in most cases. Furthermore, a recently published study supports these findings, where 3D printed shells were used to manufacture the PSIs and achieve significantly better cosmetic results than the freehand technique, according to a composite cosmetic score, based on patient- and physician-reported assessment [ 25 ]. However, no cranioplasties with orbital involvement were performed in the mentioned study.…”

Section: Discussionmentioning

confidence: 77%

“…Based on the method of cost calculation, the costs for 3D printer-assisted cranioplasty mentioned in the literature vary between 260 and 2780 USD [ 11 , 25 , 26 ]. One of the main reasons for the low cost calculation in the literature is that labor and licensing costs are often not considered.…”

Section: Discussionmentioning

confidence: 99%

“…A freehand cranioplasty costs approximately 55 USD [ 25 ]. However, possible secondary costs from revision surgeries due to inadequate cosmesis are not considered.…”

Section: Discussionmentioning

confidence: 99%

“…The costs for autologous bone flap consist mainly of the cost of cryoconservation of approximately 600 USD, while costs for potential revision surgery in case of bone resorption were not considered [ 11 ]. Industrially manufactured PSIs made of titanium, PEEK, cost approximately 5000–10,000 USD [ 12 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Clinical and patient-reported outcome after patient-specific 3D printer-assisted cranioplasty

et al. 2023

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Various cranioplasty techniques exist for the reconstruction of cranial bone defects. Patient-specific implants can be produced in-house using a recently developed 3D printer-assisted cranioplasty technique. However, the resulting cosmetic outcomes from the patient’s perspective are underreported. With our case series, we aim to present the clinical outcome, morbidity rate, patient-reported cosmetic results, and cost-effectiveness of patient-specific3D printer-assisted cranioplasty technique. This is a consecutive retrospective case series of adult patients undergoing cranioplasty using the patient-specific 3D printer-assisted technique. As primary endpoint, the functional outcome based on modified Rankin scale (mRS) at discharge and follow-up was assessed. A prospective telephone survey was conducted to collect and provide patient-reported outcomes. Thirty-one patients underwent patient-specific 3D printer-assisted cranioplasty, mostly to reconstruct frontotemporoparietal (61.3%) and frontotemporal defects with orbital involvement (19.4%). Good functional outcome (mRS ≤ 2) at discharge and during the last follow-up was achieved in 54.8% (n = 17) and 58.1% (n = 18) patients. Overall, the rate of clinically relevant surgery-related complications was 35.5% (n = 11). Postoperative epidural hematoma/collection (16.1%) and infections (12.9%) were the most frequent complications. Permanent morbidity occurred in one patient (3.2%) with postoperative acute ipsilateral vision loss after frontotemporal cranioplasty with orbital involvement. No surgery-related mortality occurred. The mean patient-reported cosmetic satisfaction score was 7.8 ± 1.5, with 80% of patients reporting satisfying or very satisfying cosmetic results. No significant differences were seen between the different defect localization regarding the cosmetic outcome. The mean manufacturing costs of a patient-specific 3D printer-assisted implant ranged from 748 to 1129 USD. Based on our case series, patient-specific 3D printer-assisted cranioplasty is cost-effective and leads to satisfying cosmetic results, especially in large defects and/or defects with complex geometry.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

“…A freehand cranioplasty costs approximately 55 USD [ 25 ]. However, possible secondary costs from revision surgeries due to inadequate cosmesis are not considered.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical and patient-reported outcome after patient-specific 3D printer-assisted cranioplasty

et al. 2023

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“…10 Both PEEK and PMMA are suitable for 3D printing. 14 This customisable manufacturing process has emerged in recent years in medicine for its potential in creating patient-specific prostheses.…”

Section: Introductionmentioning

confidence: 99%

Patient‐specific cranioplasty, by direct and indirect additive manufacturing of biopolymers and implantable materials

Flora,

Scerrati,

Trovalusci

et al. 2023

Robotics Computer Surgery

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BackgroundAutologous bones are traditionally used in surgical reconstruction of skullcap. Since patients’ bones are often unavailable or cause of infections, implantable synthetic materials emerged as promising alternative. These can be shaped by different technologies, while 3D printing offers remarkable chances in terms of flexibility, accuracy, cost‐saving and customizability.MethodsThis study aims to evaluate strengths and limitations of the three main strategies that imply additive manufacturing for the implementation of cranial prosthesis: (i) direct printing of PLA (polylactic acid) skullcaps, mould casting of poly(methyl methacrylate) (PMMA) prosthesis using (ii) silicone mould manufactured from a 3D printed master, (iii) 3Dprinted TPU (thermoplastic polyurethane) mould.ResultsAll solutions achieved good geometric accuracy and excellent mechanical resistance. Direct printing of the PLA resulted in the fastest strategy, followed by PMMA casting in a silicone mould.ConclusionsThe use of silicone was overall more advantageous, due to lower costs and the possibility of sterilization by using autoclaving.

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Cosmetic satisfaction and patient-reported outcome measures following cranioplasty after craniectomy – A prospective cohort study

et al. 2023

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Customized cost-effective polymethylmethacrylate cranioplasty: a cosmetic comparison with other low-cost methods of cranioplasty

Cited by 7 publications

References 38 publications

Clinical and patient-reported outcome after patient-specific 3D printer-assisted cranioplasty

Clinical and patient-reported outcome after patient-specific 3D printer-assisted cranioplasty

Patient‐specific cranioplasty, by direct and indirect additive manufacturing of biopolymers and implantable materials

Cosmetic satisfaction and patient-reported outcome measures following cranioplasty after craniectomy – A prospective cohort study

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