Temperature elevation during simulated polymethylmethacrylate (PMMA) cranioplasty in a cadaver model

Golz, T; Graham, Ciaren; Busch, Lüder C.; J, Wulf; Winder, R. J.

doi:10.1016/j.jocn.2009.09.005

Cited by 53 publications

(32 citation statements)

References 34 publications

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“…Correct positioning and size of the implant not only results in cosmetically favorable outcomes, but also reduces operation time for adjustment and insertion, minimizes bone flap subsidence, wound dehiscence due to tensionless wound closure, wound infection, and finally revision operations [18]. Furthermore, thermal tissue damage caused by an exothermic polymerization reaction during hardening [17] and cytotoxic damage using PMMA implants by direct molding on the lesion [24] have been reported. With the presented procedure, due to the fact that molding is indirect and removed from the involved sensitive tissue, no damage occurs using PMMA.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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Cranioplasty is a common neurosurgical procedure. Free-hand molding of polymethyl methacrylate (PMMA) cement into complex three-dimensional shapes is often time-consuming and may result in disappointing cosmetic outcomes. Computer-assisted patient-specific implants address these disadvantages but are associated with long production times and high costs. In this study, we evaluated the clinical, radiological, and cosmetic outcomes of a timesaving and inexpensive intraoperative method to mold custom-made implants for immediate single-stage or delayed cranioplasty. Data were collected from patients in whom cranioplasty became necessary after removal of bone flaps affected by intracranial infection, tumor invasion, or trauma. A PMMA replica was cast between a negative form of the patient's own bone flap and the original bone flap with exactly the same shape, thickness, and dimensions. Clinical and radiological follow-up was performed 2 months post-surgery. Patient satisfaction (Odom criteria) and cosmesis (visual analogue scale for cosmesis) were evaluated 1 to 3 years after cranioplasty. Twenty-seven patients underwent intraoperative template-molded patient-specific cranioplasty with PMMA. The indications for cranioplasty included bone flap infection (56%, n015), calvarian tumor resection (37%, n010), and defect after trauma (7%, n02). The mean duration of the molding procedure was 19±7 min. Excellent radiological implant alignment was achieved in 94% of the cases. All (n023) but one patient rated the cosmetic outcome (mean 1.4 years after cranioplasty) as excellent (70%, n016) or good (26%, n06). Intraoperative cast-molded reconstructive cranioplasty is a feasible, accurate, fast, and cost-efficient technique that results in excellent cosmetic outcomes, even with large and complex skull defects.Keywords Patient-specific implant . Cranioplasty . Skull bone flap . Bone replacement material polymethyl methacrylate-PMMA . Brain tumors . Trauma . Brain

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Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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“…39 With material biocompatibility as well as sterilization addressed, one unresolved issue remains, which is the potential effect that the temperature elevation during bone cement polymerization may have on a polylactic acid mold. In one laboratory experiment, 18 the surface temperature of the bone cement reached an average of 63.5°C during polymerization. Whether this could adversely affect the mold remains uncertain.…”

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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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“…This is reflected particularly in relation to the templating method by Kim et al 2012, with cranioplasty surgery taking 184.36 ± 26.07 min for PMMA (templated), as opposed to previously recorded values of 285 ± 128 min for alternative fabrication methods [11]. The ability to either prefabricate patient specific implants, or template these intra-operatively external to the patient, provided clear benefits by removing the risk of thermal necrosis or hypotension associated with the curing process of PMMA [74][75][76][77]. In addition, the nature of geometry generation becomes controlled through accepted physical design methodologies and computer-aided design (CAD), allowing for better form, fit and function [26,89,90]; which in turn leads to less chance of abnormal biomechanics and fit-based complications, without the need to shape or alter the implant by hand, as well as minimizing the complexity of the surgical procedure.…”

Section: Discussionmentioning

confidence: 98%

“…The curing process for PMMA is exothermic (between 70 and 120 • C). This has significant implications for in vitro use, as such temperatures can lead to death of surrounding tissue through thermal necrosis [74][75][76]. In addition, there is evidence which suggests that the curing process of PMMA can lead to cardiopulmonary complications (hypotension) [77].…”

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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Temperature elevation during simulated polymethylmethacrylate (PMMA) cranioplasty in a cadaver model

Cited by 53 publications

References 34 publications

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

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

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

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

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