Cranioplasty implants should be widely available, low in cost, and customized or easy to mold during surgery. Although autologous bone remains the first choice for repair, it cannot always be used due to infection, fragmentation, bone resorption, or other causes, which led to use of synthetic alternatives. The most frequently used allogenic material for cranial reconstructions with long-term results is polymethylmethacrylate (PMMA). Three-dimensional printing technology has allowed the production of increasingly popular customized, prefabricated implants. The authors describe their method and experience with a customized PMMA prosthesis using a precise and reliable low-cost implant that can be customized at any institution with open-source or low-cost software and desktop 3D printers.
A review of 22 consecutive patients undergoing CT-based, low-cost, customized PMMA cranioplasty over a 1-year period at a university teaching hospital was performed. Preoperative data included patient sex and age; CT modeling parameters, including the surface area of the implant (defect); reason for craniectomy; date(s) of injury and/or resections; the complexity of the defect; and associated comorbidities. Postoperative data included morbiditiy and complications, such as implant exposure, infection, hematoma, seroma, implant failure, and seizures; the cost of the implant; and cosmetic outcome.
Indications for the primary craniectomy were traumatic brain injury (16, 73%), tumor resection (3, 14%), infection (1, 4%), and vascular (2, 9%). The median interval between previous surgery and PMMA cranioplasty was 12 months. The operation time ranged from 90 to 150 minutes (mean 126 minutes). The average cranial defect measured 65.16 cm2 (range 29.31–131.06 cm2). During the recovery period, there was no sign of infection, implant rejection, or wound dehiscence, and none of the implants had to be removed over a follow-up ranging from 1 to 6 months. The aesthetic appearance of all patients was significantly improved, and the implant fit was excellent.
The use of a customized PMMA was associated with excellent patient, family, and surgeon satisfaction at follow-up at a fraction of the cost associated with commercially available implants. This technique could be an attractive option to all patients undergoing cranioplasty.
Correspondence Jesús A. Morales-Gómez: Hospital Universitario “Dr. José Eleuterio González,” Monterrey, Nuevo León, México. firstname.lastname@example.org.INCLUDE WHEN CITING Published online June 15, 2018; DOI: 10.3171/2017.12.JNS172574.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
AnchietaMVSallesFACassaroBDQuaresmaMMSantosBF: Skull reconstruction after resection of bone tumors in a single surgical time by the association of the techniques of rapid prototyping and surgical navigation. Int J CARS11:1919–19252016
AnchietaMV, SallesFA, CassaroBD, QuaresmaMM, SantosBF: Skull reconstruction after resection of bone tumors in a single surgical time by the association of the techniques of rapid prototyping and surgical navigation. 11:1919–1925, 201610.1007/s11548-016-1415-2)| false
BhargavaD, BartlettP, RussellJ, LiddingtonM, TyagiA, ChumasP: Construction of titanium cranioplasty plate using craniectomy bone flap as template. 152:173–176, 201010.1007/s00701-009-0394-219533018)| false
Caro-OsorioEDe la Garza-RamosRMartínez-SánchezSROlazarán-SalinasF: Cranioplasty with polymethylmethacrylate prostheses fabricated by hand using original bone flaps: technical note and surgical outcomes. Surg Neurol Int4:1362013
Caro-OsorioE, De la Garza-RamosR, Martínez-SánchezSR, Olazarán-SalinasF: Cranioplasty with polymethylmethacrylate prostheses fabricated by hand using original bone flaps: technical note and surgical outcomes. 4:136, 20132423282710.4103/2152-7806.119535)| false
FiaschiPPavanelloMImperatoADallolioVAccogliACapraV: Surgical results of cranioplasty with a polymethylmethacrylate customized cranial implant in pediatric patients: a single-center experience. J Neurosurg Pediatr17:705–7102016
RosenthalG, NgI, MoscoviciS, LeeKK, LayT, MartinC, : Polyetheretherketone implants for the repair of large cranial defects: a 3-center experience. 75:523–529, 20142497909610.1227/NEU.0000000000000477)| false
SharavananGMJayabalanSRajasukumaranKVeerasekarGSathyaG: Cranioplasty using presurgically fabricated presterilised polymethyl methacrylate plate by a simple, cost-effective technique on patients with and without original bone flap: study on 29 patients. J Maxillofac Oral Surg14:378–3852015
SharavananGM, JayabalanS, RajasukumaranK, VeerasekarG, SathyaG: Cranioplasty using presurgically fabricated presterilised polymethyl methacrylate plate by a simple, cost-effective technique on patients with and without original bone flap: study on 29 patients. 14:378–385, 201510.1007/s12663-014-0670-4)| false
UnterhoferCWipplingerCVeriusMRecheisWThoméCOrtlerM: Reconstruction of large cranial defects with poly-methyl-methacrylate (PMMA) using a rapid prototyping model and a new technique for intraoperative implant modeling. Neurol Neurochir Pol51:214–2202017
UnterhoferC, WipplingerC, VeriusM, RecheisW, ThoméC, OrtlerM: Reconstruction of large cranial defects with poly-methyl-methacrylate (PMMA) using a rapid prototyping model and a new technique for intraoperative implant modeling. 51:214–220, 201710.1016/j.pjnns.2017.02.007)| false