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

Marbacher, Serge; Andereggen, Lukas; Erhardt, Salome; Fathi, Ali-Reza; Fandiño, Javier; Raabe, Andreas; Beck, Jürgen

doi:10.1007/s10143-012-0376-3

Cited by 54 publications

(37 citation statements)

References 47 publications

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“…Key advantages of use lie in high immunological compatibility [36], as the implant is comprised of the patient's own tissue, as well as superior anatomical cosmesis, given it matches the injury profile directly [29]. Often, direct re-implantation of the autologous bone flap is not feasible and storage (either cryogenic or subcutaneous) is required to ensure the flap is preserved until re-implantation [21,68,69].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…4 While the polymer sets, it can be moulded into a specific shape. 5 Once hardened and cooled, it is safe for implant into humans. 5,6 The exothermic curing process of the PMMA poses a challenge for use in cranioplasty as the paste cannot be held against the cranial defect to mould due to risk of thermal injury to the brain.…”

Section: Introductionmentioning

confidence: 99%

“…5 Once hardened and cooled, it is safe for implant into humans. 5,6 The exothermic curing process of the PMMA poses a challenge for use in cranioplasty as the paste cannot be held against the cranial defect to mould due to risk of thermal injury to the brain. 2 The extreme temperatures also create difficulty in handling the paste, often leading to unsatisfactory cosmetic results.…”

Section: Introductionmentioning

confidence: 99%

“…Other international institutions identified these challenges and circumvented them by using the craniotomy bone intraoperatively to create a mirror implant with PMMA at the time of initial surgery, store it and autoclave when ready for implant. 5,6 This approach, however, becomes impractical in a high trauma environment where it is difficult to predict who will eventually require cranioplasty.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of locally manufactured patient-specific custom made implants for cranial defects using a silicone mould

Vlok¹,

Naidoo²,

Kamat³

et al. 2018

S. Afr. j. surg.

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Background: Cranial vault defects can pose a significant problem for neurosurgeons where autologous bone is no longer available for cranioplasty. Numerous materials exist to create implants which include polymethyl methacrylate (PMMA) and titanium. A technique using 3-dimensional CT scan reconstruction of a cranial defect and creating a silicon mould which can be autoclaved in theatre to create a PMMA implant was developed. Objectives: The aim of this study is to evaluate the efficacy, cosmetic result, safety and cost-effectiveness of this procedure and compare this to existing techniques. Methods: An ambispective study was performed in patients requiring cranioplasty with a custom made implant. Patients were assessed for risk factors and cosmetic outcome, surgical technique was described and complications and cost compared to existing literature between 2010 and 2016. Results: Thirty retrospective and 30 consecutive prospective patients were recruited into the study. Overall sepsis rate was 8.3%. All septic cases had superficial sepsis of which 2 grafts were removed due to cerebrospinal fluid leakage resulting in wound breakdown. A 100% accurate implant to defect ratio was achieved leading to a high satisfaction rate. Average cost was 5 times cheaper than the closest market related product. Conclusion: Patient specific moulds using PMMA to create custom implants are safe, have excellent cosmetic results and are a very cost-effective option to manage cranial defects. Accurate planning strategies for large craniotomies, where bone will potentially be discarded, add to surgical effectiveness and cost-saving to the patient.S Afr J Surg 2018;56 (3) http://dx.

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“…There are several techniques and materials available for preservation of the explanted bone-flap and its replacement [2,5,7,12,13,[16][17][18]. These techniques differ in functionality, cosmetic result, costs and spectrum of complications involved in the procedures.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative fabrication of patient-specific moulded implants for skull reconstruction: single-centre experience of 28 cases

et al. 2014

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BACKGROUND Intraoperatively fabricated polymethylmethacrylate (PMMA) implants based on computer-designed moulds were used to improve cosmetic results after hard tissue replacement. To assess the implant's cosmetic and functional results we performed both subjective and objective assessments. METHODS This retrospective analysis was performed using a cohort of 28 patients who received PMMA implants between February 2009 and March 2012. The cosmetic and functional results were assessed using a patient questionnaire. Furthermore an objective volumetric subtraction score (0-100) was applied and implant thickness, as well as gaps and tiers, were measured. RESULTS Patients mainly judged their cosmetic result as "good". Two of the 28 patients found their cosmetic result unfavourable. The functional result and stability was mainly judged to be good. Measurements of implant thickness showed a very high correlation with the thickness of the contralateral bone. Volumetric subtraction led to a median quality of 80 on a scale from 0 to 100. Median gaps around the margins of the implant were 1.5 mm parietally, 1.7 mm frontally and 3.5 mm fronto-orbitally, and median tiers were 1.2 mm, 0 mm and 0 mm respectively. The overall rate of surgical revisions was 10.7 % (three patients). Two patients suffered from wound healing disturbances (7.1 %). The overall complication rate was comparable to other reports in the literature. CONCLUSIONS Implantation of intraoperatively fabricated patient-specific moulded implants is a cost-effective and safe technique leading to good clinical results with a low complication rate. This manuscript has not been published elsewhere in whole or part. 2 AbstractBackground:

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

Cited by 54 publications

References 47 publications

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

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

Evaluation of locally manufactured patient-specific custom made implants for cranial defects using a silicone mould

Intraoperative fabrication of patient-specific moulded implants for skull reconstruction: single-centre experience of 28 cases

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