Three-Dimensional Printed Polymethylmethacrylate Casting Molds for Posterior Fossa Reconstruction in the Surgical Treatment of Chiari I Malformation: Technical Note and Illustrative Cases

Pijpker, Peter A J; Wagemakers, Michiel; Kraeima, Joep; Vergeer, Rob A; Kuijlen, Jos M. A.; Groen, Rob J. M.

doi:10.1016/j.wneu.2019.05.191

Cited by 16 publications

(12 citation statements)

References 24 publications

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“…The current literature relating to the geometric and morphological characteristics of in-hospital 3D-printed PEEK cranial PSIs is very limited. Although few studies have evaluated the accuracy of cranial reconstruction with PSIs fabricated in-hospital, these studies are primarily directed towards molded acrylic prostheses [20,22,[38][39][40]. One study focused on quantitative assessment of the dimensional accuracy of patient-specific laser-sintered PEEK cranial implants concerning the build orientation [41].…”

Section: Discussionmentioning

confidence: 99%

Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants

Sharma

Aghlmandi

Dalcanale

et al. 2021

IJMS

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Recent advancements in medical imaging, virtual surgical planning (VSP), and three-dimensional (3D) printing have potentially changed how today’s craniomaxillofacial surgeons use patient information for customized treatments. Over the years, polyetheretherketone (PEEK) has emerged as the biomaterial of choice to reconstruct craniofacial defects. With advancements in additive manufacturing (AM) systems, prospects for the point-of-care (POC) 3D printing of PEEK patient-specific implants (PSIs) have emerged. Consequently, investigating the clinical reliability of POC-manufactured PEEK implants has become a necessary endeavor. Therefore, this paper aims to provide a quantitative assessment of POC-manufactured, 3D-printed PEEK PSIs for cranial reconstruction through characterization of the geometrical, morphological, and biomechanical aspects of the in-hospital 3D-printed PEEK cranial implants. The study results revealed that the printed customized cranial implants had high dimensional accuracy and repeatability, displaying clinically acceptable morphologic similarity concerning fit and contours continuity. From a biomechanical standpoint, it was noticed that the tested implants had variable peak load values with discrete fracture patterns and failed at a mean (SD) peak load of 798.38 ± 211.45 N. In conclusion, the results of this preclinical study are in line with cranial implant expectations; however, specific attributes have scope for further improvements.

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Section: Discussionmentioning

confidence: 99%

Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants

Sharma

Aghlmandi

Dalcanale

et al. 2021

IJMS

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“…Furthermore, the individual thickening of the implant can be adapted to residual brain swelling or a thick layer of epidural scar tissue, which can be left in place avoiding incidental dural tears. Instead of applying mirroring of the contralateral skull shape or digital modelling to design implant shape -which has been described in several publications [1,2,5,10,14,20,23,26] -we use pre craniectomy CT scans for skull reconstruction whenever possible. This not only supports optimal reshaping of the patient's skull, but also saves time and simplifies the planning process.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, 3D printing has become a commonly used tool in neurosurgery [ 21 , 27 ], with a number of practical applications such as anatomic models [ 28 ], surgical education and operation planning [ 15 , 16 , 18 ]. Several ideas have been tested using 3D-printed moulds for intraoperative or preoperative formation of custom implants for cranioplasty [ 1 – 3 , 5 , 10 , 13 , 14 , 23 , 25 , 26 ], even for posterior fossa reconstructions [ 20 ]. Two main strategies have been applied: first, to 3D print a virtually designed implant and, using this as a template, to produce sterilisable silicon moulds from which the PMMA implant can be formed intraoperatively [ 2 , 5 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

The “springform” technique in cranioplasty: custom made 3D-printed templates for intraoperative modelling of polymethylmethacrylate cranial implants

et al. 2021

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Background Manual moulding of cranioplasty implants after craniectomy is feasible, but does not always yield satisfying cosmetic results. In contrast, 3D printing can provide precise templates for intraoperative moulding of polymethylmethacrylate (PMMA) implants in cranioplasty. Here, we present a novel and easily implementable 3D printing workflow to produce patient-specific, sterilisable templates for PMMA implant moulding in cranioplastic neurosurgery. Methods 3D printable templates of patients with large skull defects before and after craniectomy were designed virtually from cranial CT scans. Both templates — a mould to reconstruct the outer skull shape and a ring representing the craniectomy defect margins — were printed on a desktop 3D printer with biocompatible photopolymer resins and sterilised after curing. Implant moulding and implantation were then performed intraoperatively using the templates. Clinical and radiological data were retrospectively analysed. Results Sixteen PMMA implants were performed on 14 consecutive patients within a time span of 10 months. The median defect size was 83.4 cm2 (range 57.8–120.1 cm2). Median age was 51 (range 21–80) years, and median operating time was 82.5 (range 52–152) min. No intraoperative complications occurred; PMMA moulding was uneventful and all implants fitted well into craniectomy defects. Excellent skull reconstruction could be confirmed in all postoperative computed tomography (CT) scans. In three (21.4%) patients with distinct risk factors for postoperative haematoma, revision surgery for epidural haematoma had to be performed. No surgery-related mortality or new and permanent neurologic deficits were recorded. Conclusion Our novel 3D printing-aided moulding workflow for elective cranioplasty with patient-specific PMMA implants proved to be an easily implementable alternative to solely manual implant moulding. The “springform” principle, focusing on reconstruction of the precraniectomy skull shape and perfect closure of the craniectomy defect, was feasible and showed excellent cosmetic results. The proposed method combines the precision and cosmetic advantages of computer-aided design (CAD) implants with the cost-effectiveness of manually moulded PMMA implants.

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“…Pijpker et al have described a novel method of reconstructing the occipital bone after posterior fossa craniectomy by using a 3D-printed polymethylmethacrylate casting mold. 70 This method might help reduce the frequency of complications following posterior fossa decompression. Implant casting is highly precise and can be performed at the same time with the operation, as opposed to cranioplasty with autologous bone or titanium mesh that needs to be shaped intraoperatively by the surgeon himself and with a decreased accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…This method would, in theory, enhance the tightness of the dural closure, as well as prevent complications such as pseudomeningocele or meningitis. Pijpker et al have described a novel method of reconstructing the occipital bone after posterior fossa craniectomy by using a 3D‐printed polymethylmethacrylate casting mold 70 . This method might help reduce the frequency of complications following posterior fossa decompression.…”

Section: Discussionmentioning

confidence: 99%

Interlayer dural split technique for Chiari I malformation treatment in adult—Technical note

Florian¹,

Pop²,

Florian

2021

Int J Clin Pract

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Objective: To present an alternative surgical technique in treating cases of Chiari I Malformation with mild-to-moderate syringomyelia after decompressive suboccipital craniectomy: incising only the outer layer of the dura mater, then dissecting it from the inner layer without opening the latter. Patients and methods:We utilized this technique in a short series of three cases who were admitted to our department for mild symptoms such as intermittent headache and dissociated sensory loss in the upper limbs, caused by a Chiari Malformation Type I. The patients were placed in the sitting position. We performed a reduced median suboccipital craniectomy and resection of the posterior arch of C1 adapted to the level of tonsil descent, from a limited superior half to complete resection. Afterward, we incised the outer dural layer, while sparing the inner one. Using a fine dissector, we then split apart the outer and inner layers to the margin of the craniectomy. Through the transparency of the inner layer and the arachnoid, the cerebellum and the medulla were visible and pulsating. An autologous fascia duraplasty was then performed. Results:The postoperative course was favorable in all cases, the patients being discharged without any deficits and with complete symptom resolution. Follow-up at 3, 6, and 12 months after surgery revealed a significant reduction in brainstem compression and syringomyelia. Conclusions:Interlayer dural split technique can be used effectively in treating symptomatic cases of type I Chiari malformation in adults, with mild-to-moderate syringomyelia. It is less invasive than opening the dura and possibly more effective than decompressive craniectomy and C1 laminectomy alone. This technique must be validated in a larger case-control series. Highlight s• Chiari 1 treatment involves the decompression of the foramen magnum via craniectomy, duraplasty, and resection of cerebellar tonsils.• These methods have varying success rates and there is much debate whether more or less invasive methods are required.• Our method aims to combine the invasive and less-invasive methods by only incising the outer layer of the dura mater, without entering into the subdural spaces, and performing a duraplasty to further prevent any CSF leakage.

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Three-Dimensional Printed Polymethylmethacrylate Casting Molds for Posterior Fossa Reconstruction in the Surgical Treatment of Chiari I Malformation: Technical Note and Illustrative Cases

Cited by 16 publications

References 24 publications

Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants

Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants

The “springform” technique in cranioplasty: custom made 3D-printed templates for intraoperative modelling of polymethylmethacrylate cranial implants

Interlayer dural split technique for Chiari I malformation treatment in adult—Technical note

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