Functional and aesthetic evaluation after cranial reconstruction with polymethyl methacrylate prostheses using low-cost 3D printing templates in patients with cranial defects secondary to decompressive craniectomies: A prospective study

Abstract

Background:Cranial reconstruction surgery is a procedure used as an attempt to reestablish the cranial bone anatomy. This study evaluates the symptomatic and aesthetic improvement of patients with cranial defects secondary to decompressive craniectomies after cranial reconstruction with customized polymethyl methacrylate (PMMA) prostheses. Secondly, we aim to divide our experience in the production of these prostheses with a low-cost method.Methods:A prospective study was carried out with patients submitted to cranioplasty at the Hospital da Restauração between 2014 and 2017. A total of 63 cranioplasties were performed using customized PMMA prosthesis produced by 3D impression molds. All patients underwent a functional and aesthetic evaluation questionnaire in the preoperative period and in the sixth postoperative month.Results:Sixty-three patients underwent cranioplasty with a mean age of 33 years, ranging from 13 to 58 years, 55 males and 8 females. The mean area of the defect was 147 cm2. The mean postoperative follow-up of the patients was 21 months, ranging from 6 to 33 months. Fifty-five patients attended the 6-month postoperative consultation. All patients presented symptomatic improvement after reconstruction of the skull. The infection rate was 3.2%, 4.8% of extrusion, 1.6% of prosthesis fracture, 7.9% of extradural hematoma, 17.4% of reoperation, 5% of wound dehiscence, and 4.8% of removal of the prosthesis.Conclusion:Cranioplasty, with a customized PMMA prosthesis, improved the symptoms and aesthetic appearance of all operated patients. The use of prototypes to customize cranial prostheses facilitated the operative technique and allowed the recovery of a cranial contour very close to normal.

A Comprehensive 3D-Molded Bone Flap Protocol for Patient-Specific Cranioplasty

“…The drain was withdrawn with a ow rate <50 ml in the last 12 * After prostheses xation, the scalp aps, including galea and subcutaneous tissue, should be progressively sutured down to the implant. In the temporal region, the temporal muscle should also be included (Maricevich et al, 2018(Maricevich et al, , 2019 * The patient should be placed supine, with the shoulder at the edge of the surgical table in a neutral position. Ideally, the head should be secured by a three-pin skull xation device (May eld or Sugita model).…”

A Disposable Passive Microfluidic Device for Cell Culturing

“…It is used in the fabrication of optical components, containers, pumps, filters, oxygenators and for applications with high demands for transparency. It is also widely used in orthopedic surgery as bone cement [52][53][54].…”

Design of 3D Additively Manufactured Hybrid Structures for Cranioplasty

“…The main advantage of SLA is the high accuracy in reproducing the solid 3D model [ 27 ]. A silicone mold has been manufactured from the positive shape of the cranial defect previously realized processing polyamide powders through LS [ 28 ]. Similarly, the mold has been fabricated around the positive shape of the acrylonitrile-butadiene-styrene cranial defect manufactured through FDM [ 4 , 8 ].…”