A titanium implant for Chiari malformation Type 1 surgery

Abstract

Background: Concepts of Chiari malformation Type 1 (CM1) surgery in the present time significantly different. The most common complications are pseudomeningocele (12%) and postoperative CSF leak (5%). The development of pseudomeningocele may be associated with inappropriate restoration of bone and muscles relations. Methods: The pilot study involved 11 patients aged 24–64 years with a diagnosis of CM1 who had indications for surgical treatment. Special titanium implant enabling fixation of the occipital and cervical muscles at the projections of their normal attachments was developed, it was placed to occipital bone on the final stages of surgical intervention. Surgical technique promoted tightened wound closure neutralizing formation of “dead space” at the place of occipital craniectomy and between muscle layers. The implant was produced by direct metal laser sintering method for each patient individually. Results: There were no complications during the hospitalization and follow-up period. Postoperative MRI demonstrated adequate formation of the cisterna magna and the absence of pseudomeningocele. During follow-up period there were no signs of pseudomeningocele, CSF leak, surgical scar complications, implant-associated infections, and other complications. Conclusion: In the study group, no pseudomeningocele cases as long as any other complications associated with surgery had been revealed. The efficacy of the proposed surgical technique using the developed implant should be evaluated in clinical trials with larger patient samples. To simplify preoperative planning and manufacturing of the implant for each patient individually, a set of implants with different specified sizes was developed.

Low-Cost Cranioplasty—A Systematic Review of 3D Printing in Medicine

“…According to this study, the total time required for implant preparation has not exceeded 42 h and has resulted in a 15-fold decrease in the total costs in comparison to the other methods [ 85 ]. Titanium implants, manufactured by selective laser sintering, were used in patients with Chiari malformation Type 1 after a suboccipital craniectomy [ 86 ].…”