Translucent Customized Cranial Implants Made of Clear Polymethylmethacrylate

Abstract

Background Large skull reconstruction, with the use of customized cranial implants, restores cerebral protection, physiologic homeostasis, and one's preoperative appearance. Cranial implants may be composed of either bone or a myriad of alloplastic biomaterials. Recently, patient-specific cranial implants have been fabricated using clear polymethylmethacrylate (PMMA), a visually transparent and sonolucent variant of standard opaque PMMA. Given the new enhanced diagnostic and therapeutic applications of clear PMMA, we present here a study evaluating all outcomes and complications in a consecutive patient series. Methods A single-surgeon, retrospective, 3-year study was conducted on all consecutive patients undergoing large cranioplasty with clear PMMA implants (2016–2019). Patients who received clear PMMA implants with embedded neurotechnologies were excluded due to confounding variables. All outcomes were analyzed in detail and compared with previous studies utilizing similar alloplastic implant materials. Results Fifty-five patients underwent cranioplasty with customized clear PMMA implants. Twenty-one (38%) were performed using a single-stage cranioplasty method (ie, craniectomy and cranioplasty performed during the same operation utilizing a prefabricated, oversized design and labor-intense, manual modification), whereas the remaining 34 (62%) underwent a standard, 2-stage reconstruction (craniectomy with a delayed surgery for cranioplasty and minimal-to-no implant modification necessary). The mean cranial defect size was 101.8 cm2. The mean follow-up time was 9 months (range, 1.5–39). Major complications requiring additional surgery occurred in 7 patients (13%) consisting of 2 (4%) cerebrospinal fluid leaks, 2 (4%) epidural hematomas, and 3 (4%) infections. In addition, 3 patients developed self-limiting or nonoperative complications including 2 (4%) with new onset seizures and 1 (2%) with delayed scalp healing. Conclusions This is the first reported consecutive case series of cranioplasty reconstruction using customized clear PMMA implants, demonstrating excellent results with regard to ease of use, safety, and complication rates well below published rates when compared with other alloplastic materials. Clear PMMA also provides additional benefits, such as visual transparency and sonolucency, which is material specific and unavailable with autologous bone. Although these early results are promising, further studies with multicenter investigations are well justified to evaluate long-term outcomes.

Reflections of six neuroscientists: The influences of training at minority serving institutions

“…My current research interests reflect my dual training as a physician and a neuroscientist, where my dissertation work focused on developing and characterizing one of the first described animal models of infection-induced epilepsy (Stewart et al, 2010a(Stewart et al, , 2010b. The focus of my laboratory is to develop translational models to optimize cranial reconstruction surgeries, and perform clinical studies to improve surgical and aesthetic outcomes of adults who undergo surgery on their scalp and/or skull The focus of my laboratory is to perform clinical studies to further foster the development of multidisciplinary teams and inform payers and health-care systems, as well as translational models to optimize cranial reconstruction surgeries, in an effort to improve surgical and aesthetic outcomes of adults who undergo surgery on their scalp and/or skull (Mitchell, Anderson, et al, 2020;Mitchell, Shay, Belzberg, et al, 2020;Shay et al, 2020). death.…”

Neuroimaging through Sonolucent Cranioplasty: A Systematic Scoping Review Protocol

“…Sonolucent cranioplasty (SC) implants provide an unprecedented opportunity in adult neurosurgery to conduct neuromonitoring, evaluate hemodynamics, visually track devices located within the implant, and perform focused ultrasound treatments [ 2 , 3 , 4 , 5 , 6 ]. Current research on SC has utilized polymethylmethacrylate (PMMA), polyetheretherketone (PEEK), and polyolefin as sonolucent materials [ 7 , 8 , 9 ]. The first publication detailing diagnostic imaging through cranioplasty was published by Mursch et al in 2018 using PEEK cranioplasty implants [ 9 ].…”

“…Despite a large amount of clinical evidence supporting the use of cranioplasty and the frequency that these surgical procedures are performed, there is a dearth of knowledge about outcomes and risk factors associated with SC. Previous research on SC has been largely limited to proof-of-concept studies and case series [ 3 , 7 , 8 ].…”

Cranioplasty With Customized Craniofacial Implants and Intraoperative Resizing for Single-Stage Reconstruction Following Oncologic Resection of Skull Neoplasms

“…Near perfectly shaped custom cranial implants can be ordered and prefabricated with exact patient specific curvatures to an oversized dimension, and then modified around the edges intraoperatively for an exact fit following bone/ brain tumor resection. [11][12][13][14] There are a several case reports in the literature, where immediate reconstruction with CCI's were performed for benign and malignant skull neoplasms following bone tumor resection (i.e., meningioma, fibrous dysplasia, metastasis). All of these studies are favorable and report acceptable outcomes, a trend towards decreased operative times, and less overall surgery by avoiding a need for secondary cranioplasty or revision surgery.…”

“…Near perfectly shaped custom cranial implants can be ordered and prefabricated with exact patient specific curvatures to an oversized dimension, and then modified around the edges intraoperatively for an exact fit following bone/ brain tumor resection. 11–14…”