Customized Cranioplasty Implants Using Three-Dimensional Printers and Polymethyl-Methacrylate Casting

Kim, Bum-Joon; Hong, Ki Sun; Park, Kyung Jae; Park, Dong Hyuk; Chung, Yong Gu; Kang, Sung Ho

doi:10.3340/jkns.2012.52.6.541

Cited by 132 publications

(109 citation statements)

References 23 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…However two of eleven failed cranioplasty patients required a further revision due to recurrent infection, they also healed well at the end. We did not encounter a chronically failed patient during a mean 36 months followVarious cranioplasty techniques including molds, threedimensioned printer assistance or image-guided custom made synthetic grafts have been described in literature (8,22,23,28). However the custom made grafts have perfect match with defect and ease to apply, their cost is significantly higher compared to PMMA.…”

Section: █ Discussionmentioning

confidence: 99%

Management of failed cranioplasty

Sarı

Tönge²,

Bölükbaşı³

et al. 2015

Turkish Neurosurgery

View full text Add to dashboard Cite

ABSTRACTa convalescence period (17). This cranioplasty procedure intends to achieve two goals; one is the cosmetic improvement and the other is the functional improvement (31). Cranioplasty is one of the world's most ancient surgical procedures. The earliest known case has been identified in Peru, where a skull was unearthed with a thin gold plate covering the trepanation hole. Various autografts, allografts and xenografts have been used over the years in attempt to restore cranial vault following trepanation or trauma (3).Decompressive craniectomy has potential complications which effect long-term outcome (18,36). A very important but mostly unconsidered complication is the neurological dysfunction that can occur due to the absence of bone flap and distortion of the brain under retracted scalp. This may lead █ InTRODuCTIOn D ecompressive craniectomy (DC) has been previously described for the acute management of traumatic brain injury (1), ischemic stroke (30), subarachnoid hemorrhage (16), intracranial infections (7), dural sinus thrombosis (12), inflammatory conditions (4) and tumors (2) to decrease intracranial pressure when life-threatening. Vital importance of DC in neurological emergencies has been well understood and established over the past two decades (10,19). Although this procedure is a very helpful tool in management of acute patients, may also lead to further requirement for reconstruction and complications.Patients survived from the above mentioned acute neurologic states require reconstruction of the cranial vault following AIM: Failed cranioplasty attempts may lead to numerous complications in a broad spectrum including cosmetic problems, infection, neurological deterioration and even death. Selection of the most appropriate surgical technique for second and further surgical attempts for these patients still remains a debate. We aimed to share our experience and technical pitfalls on management of failed cranioplasty, particularly for patients with large cranial defects. MATERIAL and METhODS:A retrospective data analysis of cranioplasty cases in our series was performed including the time period between 2002 and 2012. Patients required recurrent cranioplasty were analyzed in detail. RESuLTS:Totally, 101 patients underwent cranioplasty for bony defect. Of 101 patients, eleven required a revision surgery due to infection or spontaneous resorption of the bone flap. All patients underwent revision cranioplasty with pre-surgical plaster cast mold technique modified from previous studies and/or tissue expansion technique. Polymethyl-metacrylate (PMMA) was used as substitute for reconstructions. Mean follow-up was 36 months. Two out of eleven cases (18.1%) developed major complications, which led to further revision. At the end, a satisfactory reconstruction was achieved for all patients.COnCLuSIOn: Our modified molded plaster cast technique is a safe and cost-effective approach for the revision of failed cranioplasty. We believe that the tissue expanding techniques have also great contribution to achi...

show abstract

Section: █ Discussionmentioning

confidence: 99%

Management of failed cranioplasty

Sarı

Tönge²,

Bölükbaşı³

et al. 2015

Turkish Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Using the example of PMMA implants for cranioplasty and craniofacial reconstruction, it can be observed that both the prefabricated and templated methods of implant production are considered to minimize potential surgical timeframes, whilst also reducing variance in surgical time between surgeries. This is reflected particularly in relation to the templating method by Kim et al 2012, with cranioplasty surgery taking 184.36 ± 26.07 min for PMMA (templated), as opposed to previously recorded values of 285 ± 128 min for alternative fabrication methods [11]. The ability to either prefabricate patient specific implants, or template these intra-operatively external to the patient, provided clear benefits by removing the risk of thermal necrosis or hypotension associated with the curing process of PMMA [74][75][76][77].…”

Section: Discussionmentioning

confidence: 99%

“…• Increased Surgical Time [6,10,11] The literature suggests that increased surgical time dramatically increases the risk of infection. Longer surgical times (greater than 4 h) were associated with a higher risk of infection.…”

Section: Discussionmentioning

confidence: 99%

“…This example can be considered in the case of easily alterable materials (PMMA, porous polyethylene, titanium mesh, etc.) which can be readily shaped using commonly available surgical tools [11,25,84,85,91] and adapted to meet anatomical requirements which may not be visible or known prior to surgery. However, for certain applications, such as titanium plate, this is not appropriate as intraoperative alteration of the implant is near impossible without specialized tools.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

et al. 2017

View full text Add to dashboard Cite

Background: Analysis of current literature highlights a wide variation in reported infection risk for different materials in cranial repair. The purpose of these composite materials are to mimic natural bone and assist in restoring function (structurally and aesthetically) to the human skull. This review aims to examine the meta-data in order to provide an amalgamated overview of potential trends between implant material, manufacturing method and infection risk, in order to provide a core reference point for future studies surrounding emerging biomedical materials in the fields of cranioplasty by providing base point for understanding the capabilities and limitations of current technologies. Methods: A search for articles was conducted, with the following criteria seen as fundamental in providing an accurate picture of the current landscape: publication in the last decade, provision of a numerical value for both number of implants and infection cases, patient sample of 10+, adult patients, and cranioplasty/cranial repair. Results: A total of 41 articles were seen to meet the author's inclusion criteria. Average infection rates per material ranged between 2.04% and 10.98%. The results indicate that there is variation between materials in regards to total infection risk, however, depending on the materials compared, this value may be insignificant. Alternative risk factors associated with infection, including surgical time, revisions and previous infection, have a greater impact on infection potential than material variation. Comparison of fabrication methods did highlight a notable effect on average infection rate. Trends can be observed showing that materials with greater levels of surface interaction and active support of tissue ingrowth presented greater infection resistance. Such characteristics are due to the physical structures of the implants. Conclusions: It can be said that the manufacturing methods can influence biomedical materials to assist in minimizing implant infection risk.

show abstract

“…7,11 While such materials are certainly acceptable in adults, we disapprove of their use in the skull of a growing child because they may destabilize with growth. 2,4 Nevertheless, by using 3D printing to develop specific tools to facilitate the creation of a solitary split graft from multiple bone pieces and bioabsorbable plates, the surgeon can circumvent the problems posed by even the thinnest and most brittle of pediatric skulls.…”

Section: Discussionmentioning

confidence: 99%

Use of a customized 3D “basket” to create a solitary split-thickness cranial graft from numerous split fragments in an infant

Sandler

Tepper

Goodrich

et al. 2014

PED

View full text Add to dashboard Cite

While autologous split calvaria remains the preferred material for use in pediatric cranioplasty, it may be difficult to split the bone neatly into two distinct pieces, especially in infants and young children. In this paper, the authors present a technique in which numerous split pieces of bone can be readily joined together and conformed to the shape of the specific defect using a customized template and 3D trellis-like basket.

show abstract

Customized Cranioplasty Implants Using Three-Dimensional Printers and Polymethyl-Methacrylate Casting

Cited by 132 publications

References 23 publications

Management of failed cranioplasty

Management of failed cranioplasty

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

Use of a customized 3D “basket” to create a solitary split-thickness cranial graft from numerous split fragments in an infant

Contact Info

Product

Resources

About