Next-generation personalized cranioplasty treatment

Jegadeesan, Jeyapriya Thimukonda; Baldia, Manish; Basu, Bikramjit

doi:10.1016/j.actbio.2022.10.030

Cited by 11 publications

(10 citation statements)

References 149 publications

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“…The cost of cranioplasty materials for BBP mainly included the reagents of autogenous BMSCs extracting and culturing, consumable materials of 3D printing, and the labor cost. In the end, 6 weeks-6 months after decompressive craniectomy is generally considered as the proper time for cranioplasty in clinical practice [26,27]. In our BBP strategy, the preparatory time was 6 weeks-2 months for in vitro stem cells culture and AB particles and the printing time was less than 1 h. While the preparatory time for current clinical cranioplasty materials (titanium and PEEK) was 1 d-1 week for customization and aseptization.…”

Section: Discussionmentioning

confidence: 99%

“…Both cranioplasty strategies can meet the clinical requirement and complete the customized implant (table 1). Although more cranioplasty strategies such as extracellular matrix (ECM) -inspired 3D printing, injectable cell-loaded hydrogel and cell-seeding scaffolds [27][28][29] have been developed recently, ECM-inspired 3D printing could not be used as stem cell-delivery vehicles; injectable cell-loaded hydrogel has not the ability to provide 3D architecture and mechanical stability; cell-seeding scaffolds increased the risk of infection when in vitro culture. The invention of BBP broke through the limitation of these strategies, for our BBP is performed surgically, which is important to reduce infection risk.…”

Section: Discussionmentioning

confidence: 99%

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3D bioprinted autologous bone particle scaffolds for cranioplasty promote bone regeneration with both implanted and native BMSCs

Huan

Zhou

et al. 2023

Biofabrication

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Although autologous bone grafting is considered to be the gold standard for cranioplasty, unresolved problems remain, such as surgical-site infections and bone flap absorption. In this study, an autologous bone (AB) scaffold was constructed via three-dimensional (3D) bedside-bioprinting technology and used for cranioplasty. To simulate the skull structure, a polycaprolactone shell was designed as an external lamina, and 3D-printed AB and a bone marrow-derived mesenchymal stem cell (BMSC) hydrogel was used to mimic cancellous bone for bone regeneration. Our in vitro results showed that the scaffold exhibited excellent cellular affinity and promoted osteogenic differentiation of BMSCs in both 2D and 3D culture systems. The scaffold was implanted in beagle dog cranial defects for up to 9 months, and the scaffold promoted new bone and osteoid formation. Further in vivo studies indicated that transplanted BMSCs differentiated into vascular endothelium, cartilage, and bone tissues, whereas native BMSCs were recruited into the defect. The results of this study provide a method for bedside bioprinting of a cranioplasty scaffold for bone regeneration, which opens up another window for clinical applications of 3D printing in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

3D bioprinted autologous bone particle scaffolds for cranioplasty promote bone regeneration with both implanted and native BMSCs

Huan

Zhou

et al. 2023

Biofabrication

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“…Cranioplasty, a century-old treatment that improves structural and functional outcomes, is still used Thimukonda Jegadeesan et al [33] 2022 today. Surgical treatments and implant materials have evolved over time and now have a good cosmesis.…”

Section: Mangano Et Al [32] 2013mentioning

confidence: 99%

The Utility of 3D Printing for Surgical Planning and Patient-Specific Implant Design in Maxillofacial Surgery: A Narrative Review

Singh,

Bhola,

Reche

2023

Cureus

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Maxillofacial reconstructive implants are typically created in standard shapes and have a widespread application in head and neck surgery. During surgical procedures, the implant must be correctly bent according to the architecture of the particular bones. Bending takes practice, especially for untrained surgeons. Furthermore, repeated bending may increase internal stress, resulting in fatigue in vivo under masticatory loading and an array of consequences, including implant failure. There is a risk of fracture, screw loosening, and bone resorption. Resorption, infection, and displacement are usually associated with the use of premade alloplastic implants and autogenous grafts. Recent technological breakthroughs have led to the use of patient-specific implants (PSIs) developed by computer-designed additive manufacturing in reconstructive surgery. The use of computer-designed three-dimensional (3D)-printed PSI allows for more precise restoration of maxillofacial deformities, avoiding the common difficulties associated with premade implants and increasing patient satisfaction. Additive manufacturing is something that refers to a group of additive manufacturing methods. This technique has been quickly used in a variety of surgical procedures. The exponential expansion of this technology can be attributed to its enormous surgical value. Adding 3D printing to a medical practice can be a rewarding experience with stunning results.

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“…3,4 A broad spectrum of natural and synthetic materials, such as autografts and alloplasts, have been used for decades in cranioplasty surgeries. [1][2][3][4] However, the use of a patient's own flap, namely, autograft, possesses a considerable set of demerits, including the unavailability of the autologous skull bone due to fragmentation, tumour infiltration, and bone resorption. 5 Therefore, alloplastic materials like titanium, acrylic resin, and polyether ether ketone (PEEK) have been clinically investigated and explored.…”

Section: Introductionmentioning

confidence: 99%

“…Over the past few years, decompressive craniectomy (DC) has gained significant attention for the treatment and management of neurological emergencies like traumatic brain injury (TBI), ischemic stroke, brain haemorrhage, acute subdural hematoma, ruptured aneurysms, etc. 1,2 Cranioplasty is the reconstructive surgical procedure to restore the cranial defect developed from a previous DC after the neurological disorder and cerebral swelling subsided. 2,3 Due to the deprivation of the protective cranial vault in the defect area, the brain and central nervous system (CNS) become vulnerable to the external environment.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive functional outcome analysis and importance of bone remodelling on personalized cranioplasty treatment using Poly(methyl methacrylate) bone flaps

Iratwar,

Roy Chowdhury,

Pisulkar

et al. 2024

J Biomater Appl

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Cranioplasty involves the surgical reconstruction of cranial defects arising as a result of various factors, including decompressive craniectomy, cranial malformations, and brain injury due to road traffic accidents. Most of the modern decompressive craniectomies (DC) warrant a future cranioplasty surgery within 6–36 months. The conventional process of capturing the defect impression and polymethyl methacrylate (PMMA) flap fabrication results in a misfit or misalignment at the site of implantation. Equally, the intra-operative graft preparation is arduous and can result in a longer surgical time, which may compromise the functional and aesthetic outcomes. As part of a multicentric pilot clinical study, we recently conducted a cohort study on ten human subjects during 2019–2022, following the human ethics committee approvals from the participating institutes. In the current study, an important aspect of measuring the extent of bone remodelling during the time gap between decompressive craniectomy and cranioplasty was successfully evaluated. The sterilised PMMA bone flaps were implanted at the defect area during the cranioplasty surgery using titanium mini plates and screws. The mean surgery time was 90 ± 20 min, comparable to the other clinical studies on cranioplasty. No signs of intra-operative and post-operative complications, such as cerebrospinal fluid leakage, hematoma, or local and systemic infection, were clinically recorded. Importantly, aesthetic outcomes were excellent for all the patients, except in a few clinical cases, wherein the PMMA bone flap was to be carefully customized due to the remodelling of the native skull bone. The extent of physiological remodelling was evaluated by superimposing the pre-operative and post-operative CT scan data after converting the defect morphology into a 3D model. This study further establishes the safety and efficacy of a technologically better approach to fabricate patient-specific acrylic bone flaps with improved surgical outcomes. More importantly, the study outcome further demonstrates the strategy to address bone remodelling during the patient-specific implant design.

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Next-generation personalized cranioplasty treatment

Cited by 11 publications

References 149 publications

3D bioprinted autologous bone particle scaffolds for cranioplasty promote bone regeneration with both implanted and native BMSCs

3D bioprinted autologous bone particle scaffolds for cranioplasty promote bone regeneration with both implanted and native BMSCs

The Utility of 3D Printing for Surgical Planning and Patient-Specific Implant Design in Maxillofacial Surgery: A Narrative Review

Comprehensive functional outcome analysis and importance of bone remodelling on personalized cranioplasty treatment using Poly(methyl methacrylate) bone flaps

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