Materials used in cranioplasty: a history and analysis

Shah, Aatman; Jung, Henry; Skirboll, Stephen

doi:10.3171/2014.2.focus13561

Cited by 313 publications

(338 citation statements)

References 25 publications

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“…37,51 Many synthetic materials have been used successfully in cranioplasty. 20,42,43 Today, commonly used synthetic materials include acrylic, hydroxyapatite, titanium, ceramics, and polyetheretherketone (PEEK). 43 Although all of these materials may be used to produce prefabricated patientspecific implants, acrylic and hydroxyapatite are available in cement form that can be shaped intraoperatively.…”

mentioning

confidence: 99%

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

Tan¹,

Ling²,

Dinesh³

2016

JNS

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T he reconstruction of a skull vault defect, termed cranioplasty, has a rich and fascinating history. For at least 5 millennia, surgeons have patched cranial defects with an immensely diverse range of materials ranging from fruit shells to sheep scapulae and man-made plastics. 42 Even today, the pursuit of the perfect cranioplasty material and technique continues.Skull defects are often the direct result of surgical decompressive craniectomy performed for acute neurosurgical emergencies. 23 The use of a patient's original bone flap for cranioplasty is theoretically sound and avoids the problems related to the use of bone from other sources, such as human cadavers (allografts) or animals (xenografts), or the use of synthetic materials. In practice, however, cranioplasty using these bone flaps, which have been stored for a period of time either in a surgically created subcutaneous pocket or in a medical freezer, is plagued with a not insignificant risk of infections and bony resorption. 8,11,22 With unnatural storage, the nature and content of these bone flaps are changed permanently, hindering successful reincorporation as part of the skull vault. Loss of osteogenesis probably plays a role; studies on human calvarial bone flaps have shown a diminution of osteoblasts after both subcutaneous 44 The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer eddie t. w. tan, mrcsed, Ji min ling, mrcsed, and shree Kumar dinesh, FrcsDepartment of Neurosurgery, National Neuroscience Institute, Singapore obJective Commercially available, preformed patient-specific cranioplasty implants are anatomically accurate but costly. Acrylic bone cement is a commonly used alternative. However, the manual shaping of the bone cement is difficult and may not lead to a satisfactory implant in some cases. The object of this study was to determine the feasibility of fabricating molds using a commercial low-cost 3D printer for the purpose of producing patient-specific acrylic cranioplasty implants. methods Using data from a high-resolution brain CT scan of a patient with a calvarial defect posthemicraniectomy, a skull phantom and a mold were generated with computer software and fabricated with the 3D printer using the fused deposition modeling method. The mold was used as a template to shape the acrylic implant, which was formed via a polymerization reaction. The resulting implant was fitted to the skull phantom and the cranial index of symmetry was determined. results The skull phantom and mold were successfully fabricated with the 3D printer. The application of acrylic bone cement to the mold was simple and straightforward. The resulting implant did not require further adjustment or drilling prior to being fitted to the skull phantom. The cranial index of symmetry was 96.2% (the cranial index of symmetry is 100% for a perfectly symmetrical skull). coNclusioNs This study showed that it is feasible to produce patient-specific acrylic cranioplasty implants with a low-cost 3D printer. Further studies...

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mentioning

confidence: 99%

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

Tan¹,

Ling²,

Dinesh³

2016

JNS

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“…It is difficult to state the exact number of particular types of cranioplastic substances. The majority of cranial recon structions seems to be performed with poly methyl meth acrylate (PMMA) (known also as bone cement), accord ing to estimates by 2 producers interviewed on that matter and based on the review of literature [7,8]. A substance which seems to have some important ad vantages over other materials used for cranioplastic pur poses in the past was created in Łódź in mid 1980s.…”

Section: Methodsmentioning

confidence: 84%

Cranioplasty as the return-to-work factor – 112 patients with cranial defects treated in the Department of Neurosurgery at the Medical University Of Lodz

Kasprzak

Ormezowska

Jaskólski

2017

Int J Occup Med Environ Health

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Objectives: The number of craniectomies and the consequent reconstructive procedures has grown during the past decades. Cranial defects and methods of their repair could have some influence on work capability of the patients and their employ ability. Material and Methods: The authors analyzed a group of 112 patients with cranial defects treated in the Department of Neurosurgery at the Medical University of Lodz, Poland, in the course of the katamnestic period longer than 6 months after reconstructive operation, and observed them between February 2008 and February 2015. Their work capability and employment were compared, all the patients were interviewed concerning the reasons for not working according to the So cial Insurance Institution predication procedure. Results: Before the cranioplasty, all the patients were capable of work ing without limitations according to biological criteria and 89 of them were employed. Twenty-three not working people consisted of 6 pupils, 7 retired and 10 not working for other reasons. During the period between the craniectomy and the cranioplasty, 88 patients were capable of working and only 2 were employed. After the reconstruction, 93 were capable of working without limitations and 16 -with limitations. Forty-seven were employed during the period of the follow-up, the rest of patients consisted of 2 pupils, 13 retired and 50 not working for various reasons. Conclusions: Cranioplasty is a very important factor contributing to return to work. This outcome may be seen as having a great social value and be add ed to the functions of cranial repair as protective, esthetic and normalizing the intracranial pressure previously described in the literature. Int J Occup Med Environ Health 2017;30(5):803-809

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“…HA is not capable of withstanding high loads and, as such, is not as suited for larger defects when compared to other implantable materials [4,5]. HA remains relatively costly when compared to other non-metal implant materials [3].…”

Section: Discussionmentioning

confidence: 99%

“…Autologous bone stands as an anomaly when we consider both ISF and TAB values. When we consider its nature, a direct reimplantation of removed host tissue, we note that it has high potential for complete reintegration given the lack of foreign material introduction [5]; providing the patient with a completely regenerative (in the sense that the host tissue is completely replaced) solution. As such, it can be considered to have a potential IMF and TAB value of 3, representing full integration and regeneration.…”

Section: Autologous Bonementioning

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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Materials used in cranioplasty: a history and analysis

Cited by 313 publications

References 25 publications

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

Cranioplasty as the return-to-work factor – 112 patients with cranial defects treated in the Department of Neurosurgery at the Medical University Of Lodz

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

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