Background: Cranioplasty is a commonly performed neurosurgical procedure used to repair defects of the cranial vault. For large defects, 3D printing allows for the creation of patient-specific synthetic cranioplasties. Although these implants provide excellent cosmetic results for patients, costs are quite high. This makes their routine use challenging in the current Canadian healthcare environment. The purpose of this study is to report our experience with a novel, cost-effective method for cranioplasty using desktop 3D printers to manufacture patient-specific molds to aid in the shaping of polymethyl methacrylate (PMMA) cranioplasty intraoperatively. Methods: A retrospective review of patients who underwent cranioplasty utilizing 3D printed custom molds was conducted at a single center between 2018 and 2020. Either a two-piece self-align or open-air mold was utilized. Material cost, as well as demographic, clinical, and radiologic data, was reviewed. A five-point ordinance scale was used to evaluate patient satisfaction with cosmesis. Results: Four patients had previous craniectomies with infected bone flaps, 2 patients had significant bony destruction from tumor invasion, and 1 patient had bone flap resorption. Three patients underwent an open-air mold technique with a Ti-mesh/PMMA-combined implant. The remaining 4 patients underwent two-piece mold with PMMA-only implant. All patients had ‘Good’ to ‘Excellent’ cosmetic outcome with one post-operative acute subdural hematoma and one post-operative infection. Two-piece mold resulted in improved cosmetic outcome and cost savings. Conclusions: 3D printing can be used in a cost-effective manner to deliver good cranioplasty cosmesis. Wider adoption of this technique can result in significant healthcare cost savings without compromising patient outcome.

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Background: Cranial reconstruction is a common consequence of neurosurgical disease and intervention following craniectomy, trauma, infection, congenital defects, or neoplasm. Most commonly, Computer Aided Design-Computer Aided Manufacturing (CAD-CAM) technology is utilized in cases where autologous bone cannot be used. These patient-specific implants provide excellent cosmesis, however individual costs range from $800-15,000, making routine use challenging in the current Canadian health care environment. Here we present a novel method using desktop 3D printers to manufacture patient-specific molds for intraoperative reconstruction of various cranial defects. Methods: Our first patient presented following two separate traumas requiring decompressive craniectomy and subsequent posterior fossa decompression without interval cranioplasty. The second patient required reconstruction during resection of intraosseous meningioma. Both cases were performed using a titanium-mesh/poly-methyl-methacrylate (Ti-PMMA) construct draped over the mold. The third case, cranioplasty following decompressive craniectomy outside the country, was performed using a “two piece” mold and PMMA was casted into the mold and allowed to harden. Results: Patients reported satisfaction with cosmesis, without adverse outcomes. Cost per case was $50-100, representing an estimated cost savings of $685,000 per year in Canada. Conclusions: Given excellent outcomes in addition to cost effectiveness, this case series provides evidence for use of this alternate technique with similar patient outcomes.

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