Reverse engineering techniques for cranioplasty: a case study

Maravelakis, Emmanuel; David, Constantine; Antoniadis, Aristomenis; Manios, Andreas; Bilalis, Nikolaos; Papaharilaou, Yannis

doi:10.1080/03091900600700749

Cited by 37 publications

(19 citation statements)

References 20 publications

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“…In the past 20 years or so, much has been achieved through research on the techniques to produce customized cranioplasty implants. 13,14,19,21,27,34,36,48,49,54,56 Nevertheless, these impressive techniques have generally remained in the respective laboratories and universities in which they were developed. This is because they require technical expertise as well as expensive, sophisticated software and machinery that are beyond the means of most surgeons and hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…40 With computer 3D modeling software and the patient's neuroimaging data, a mold can be designed, fabricated with this technology, and used to shape acrylic bone cement into an implant with good results. 27,36 Although promising, this method has not been widely adopted, at least in part due to limited access to expensive commercial and industrial 3D printers. The proliferation of low-cost desktop 3D printers has the potential to change this.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…The use of the patients' diagnostic and defective images with the aid of active contour model, and image registration techniques, were effective in modeling the skull's original shape. This approach differs from mirroring techniques, which assume that contralateral skull information is available [13,14,19,28]. However, patients with defects crossing the midsagittal plane of the brain, or those with a bilateral craniotomy do not fulfill this condition.…”

Section: Discussionmentioning

confidence: 98%

“…The most popular one is the mirroring technique that duplicates the healthy counterpart section from the opposite side of the skull, as a model for the mold. Although this method has many applications [13,14,19,28], it uses the assumption of the ideal bilateral symmetry of the human skull [25]. Besides, mirroring is suitable only for the unilateral damage, and is unable to deal with bilateral defects.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional reconstruction of cranial defect using active contour model and image registration

Liao

Sun

et al. 2010

Med Biol Eng Comput

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In neurosurgery, cranial incisions during craniotomy can be recovered by cranioplasty--a surgical operation using cranial implants to repair skull defects. However, surgeons often encounter difficulties when grafting prefabricated cranial plates into defective areas, since a perfect match to the cranial incision is difficult to achieve. Previous studies using mirroring technique, surface interpolation, or deformed template had limitations in skull reconstruction to match the patient's original appearance. For this study, we utilized low-resolution and high-resolution computed tomography images from the patient to repair skull defects, whilst preserving the original shape. Since the accuracy of skull reconstruction was associated with the partial volume effects in the low-resolution images and the percentage of the skull defect in the high-resolution images, the low-resolution images with intact skull were resampled and thresholded followed by active contour model to suppress partial volume artifacts. The resulting low-resolution images were registered with the high-resolution ones, which exhibited different percentages of cranial defect, to extract the incised cranial part. Finally, mesh smoothing refined the three-dimensional model of the cranial defect. Simulation results indicate that the reconstruction was 93.94% accurate for a 20% skull material removal, and 97.76% accurate for 40% skull material removal. Experimental results demonstrate that the proposed algorithm effectively creates a customized implant, which can readily be used in cranioplasty.

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“…Overcoming such difficulties, the latest reverse-engineering technique is becoming the standard for medical modeling, using computed tomography (CT) images to reconstruct the anatomy of interest. 17 A GE Medical Systems Lightspeed VCT (GE Healthcare, Waukesha, Wis) scanner was employed for the noninvasive extraction of high-resolution anatomic information of Myrtis' skull (the CT acquisition parameters were 120 KVp, 364 mAs, 21.2 cm field of view, 650 slices, slice increment 0.3 mm, 0.414 pixel size, and 512 3 512 image matrix size; Figure 2), while the Materialise Mimics (Materialise, Leuven, Belgium) software was used to produce the skull model segmentation from the CT images. Threedimensional visualization was performed by means of triangulation of a segmented 3D area.…”

Section: Case Reportmentioning

confidence: 99%

Facial reconstruction of an 11-year-old female resident of 430 BC Athens

Papagrigorakis¹,

Synodinos²,

Antoniadis³

et al. 2011

The Angle Orthodontist

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Although modern standards of ideal proportions and facial esthetics are based mostly on observations of human faces as depicted in Classical Greek masterpieces of art, the real faces of ordinary ancient Greeks have, until now, remained elusive and subject to the imagination. Objective forensic techniques of facial reconstruction have never been applied before, because human skeletal material from Classical Greece has been extremely scarce, since most decent burials of that time required cremation. Here, the authors show stage by stage the facial reconstruction of an 11-year-old girl whose skull was unearthed in excellent condition from a mass grave with victims of the Plague that struck Athens of 430 BC. The original skull was replicated via three-dimensional modeling and rapid prototyping techniques. The reconstruction followed the Manchester method, laying the facial tissues from the surface of the skull outward by using depthmarker pegs as thickness guides. The shape, size, and position of the eyes, ears, nose, and mouth were determined according to features of the underlying skeletal tissues, whereas the hairstyle followed the fashion of the time. This is the first case of facial reconstruction of a layperson residing in Athens of the Golden Age of Pericles. It is ironic, however, that this unfortunate girl who lived such a short life in ancient Athens, will now, 2500 years later, have the chance to travel and be universally recognizable in a world much bigger than anybody in ancient Athens could have ever imagined. (Angle Orthod. 2011;81:169-177.)

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Reverse engineering techniques for cranioplasty: a case study

Cited by 37 publications

References 20 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

Three-dimensional reconstruction of cranial defect using active contour model and image registration

Facial reconstruction of an 11-year-old female resident of 430 BC Athens

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