Alloplastic cranial implants made from computed tomographic scan-generated casts

Putten, Meade C. van; Yamada, Shuhei

doi:10.1016/0022-3913(92)90294-k

Cited by 30 publications

(15 citation statements)

References 23 publications

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“…De fects involving the frontal sinus should involve oblitera tion of the sinus, and perhaps the use of methyl methacry late should be avoided completely [6], Larger cranioplasties have much less tensile strength than that of normal skull, and are more likely to have later breakage and dislodgment. Preprocessed cranial implants generated from three-dimensional casts of the skull through computed tomography and computer-aided de sign reformation reduce surgical time, and may be the technique of choice for large cranial defects [10]. In some instances, small skull defects may close spontaneously if the dura mater and the pericranium are intact [11].…”

Section: Discussionmentioning

confidence: 99%

Methyl Methacrylate Cranioplasty in Children: Long-Term Results

Blum

Schneider

Rosenthal³

1997

Pediatr Neurosurg

153

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The long-term outcome of 75 children who underwent methyl methacrylate cranioplasty over a 15-year period is presented. Forty-two patients underwent cranioplasty for posttraumatic skull defects and 33 for nontraumatic causes. Within 8 years following initial cranioplasty procedure, a total of 17 (23%) complications occurred. Several factors correlated with the development of complications, including postoperative radiotherapy, the size of the defect, involvement of the frontal sinus, and the presence of prior infection. The authors currently recommend avoiding methyl methacrylate cranioplasty in selected patients who have received postoperative radiation therapy, in patients with large cranial defects, involvement of the frontal sinus, or any history of prior infection.

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Section: Discussionmentioning

confidence: 99%

Methyl Methacrylate Cranioplasty in Children: Long-Term Results

Blum

Schneider

Rosenthal³

1997

Pediatr Neurosurg

153

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“…With the advent of digitally programmed 3-D models of skull, the exact dimensions of the defect can be generated on which an accurately contoured prosthesis can be designed [16]. Although heat cured methylmethacrylate implant and titanium mini plate and screws have been giving gratifying results, the search for better and biodegradable material for reconstruction of cranial defects is under trials.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Cranial Defects in Armed Forces Personnel - Our Experience

Bandyopadhyay¹,

Thapliyal

2005

Medical Journal Armed Forces India

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Background: The aim of this study was to evaluate the efficacy of heat cured 'poly methyl methacrylate resin prosthesis and to assess the acceptability of the indigenously manufactured titanium mini bone plate and screws in patients treated for repair of cranial defects. Methods: 17 patients with cranial defect were treated for reconstruction of the skull defect with two types of implants i.e. Acrylic resin plate prosthesis and titanium minibone plates, either in combination or singularly. In these cases, the skull defects resulted from trauma (88.23%) or due to ablative tumour surgery (11.96%). Acrylic implant was used in 12 cases (70.85%), titanium plates and screws in 2 cases (11.76%) and a combination of both of the above in 3 cases (17.64). Results: The primary reconstruction was carried out in 2 cases (11.96%) and secondary reconstruction was done in 15 cases (88.23%). Majority of the cases underwent secondary reconstruction because of the initial surgical emergency requiring quick debulking and closure. In 2 cases where primary reconstruction was done, the second surgery could be avoided with gratifying results. Conclusion: 70.85% underwent reconstruction with polymethyl methacrylate resin prosthesis and in the rest either titanium plates were used singly or in combination. Only in one patient, there was rejection of the implant due to infection. In 94% cases the graft was well taken up with excellent results. MJAFI 2005; 61 : 36-40

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“…First, the high costs associated with custom prefabricated implants generally restrict its application to only the most complex defects (18). Second, prefabricated implants are designed to fit a specific defect and are, therefore, limited to patients with fixed skull defects whose size and geometry are known preoperatively.…”

Section: Discussionmentioning

confidence: 99%

A technique for intraoperative creation of patient-specific titanium mesh implants

Sunderland¹,

Edwards²,

Mainprize³

et al. 2015

CAN J PLAST SURG

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C alvarial reconstruction following trauma, tumour excision or craniotomy is a common procedure performed by craniofacial surgeons and neurosurgeons. Alloplastic cranioplasty using materials such as titanium mesh, polymethyl methacrylate (PMMA) and polyether ether ketone, offers many advantages over autologous cranioplasty including unlimited availability, elimination of donor site morbidity, permanent shape and volume retention, and relative ease of manipulation during surgery (1). In current practice, there are two primary methods of alloplastic cranioplasty: manual intraoperative contouring of the alloplastic cranioplasty material to fit the skull defect in situ; or use of prefabricated, patient-specific implants.Simple skull defects are adequately reconstructed by manual intraoperative shaping of titanium mesh or molding of PMMA in situ. However, accurate restoration of normal skull shape by manual contouring is exceedingly difficult for large defects with complex surface geometry. Prefabricated patient-specific implants, designed using a patient's computed tomography (CT) data to precisely restore the missing anatomy, are increasing in popularity as a surgical solution for these more complex cranial defects. These implants reduce surgical complexity, decrease operative times, minimize exposure and risk of contamination, and have resulted in improved cosmesis and patient satisfaction (1,2).The fabrication of custom implants normally relies on preoperative processing of the patient's CT data, the computer-assisted design of a virtual implant model and subsequent manufacture of the implant. The implant is prefabricated well in advance of surgery for a stable, unalterable skull defect that must be clearly defined before the planned operative procedure. Herein lies the major disadvantage of prefabricated, patient-specific cranioplasty implants. An unanticipated intraoperative finding requiring modification of the defect, renders the implant useless. More importantly, in all surgical procedures in which the size of the defect is not known before surgery, prefabricated implants cannot be used. Patient-specific implants are, therefore, not available to patients undergoing ablative tumour surgery, trauma surgery, or any cranial vault reconstructions potentially requiring intraoperative resection or modification.The optimal method for alloplastic cranioplasty would enable costeffective creation of a patient-specific implant with the capacity for intraoperative modification. The present article describes a technique that uses a patient's CT scan data to create a custom forming tool (ie, mold) that enables intraoperative creation of a custom titanium mesh implant. These implants have the unique capacity for intraoperative modification in the event that the size of the defect is unknown preoperatively, or if alteration of an existing skull defect is required. Representative surgical cases will be presented, demonstrating the ability of this technique to achieve anatomical restoration of virtually any calvarial shape and...

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Alloplastic cranial implants made from computed tomographic scan-generated casts

Cited by 30 publications

References 23 publications

Methyl Methacrylate Cranioplasty in Children: Long-Term Results

Methyl Methacrylate Cranioplasty in Children: Long-Term Results

Reconstruction of Cranial Defects in Armed Forces Personnel - Our Experience

A technique for intraoperative creation of patient-specific titanium mesh implants

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