Cost-Effective Cranioplasty Utilizing 3D Printed Molds: A Canadian Single-Center Experience

Abstract

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.

Augmented reality–assisted craniofacial reconstruction in skull base lesions — an innovative technique for single-step resection and cranioplasty in neurosurgery

“…With these, only minimal deviations from the original surface profile and an excellent esthetic appearance can be assumed. Reports on less expensive implants manufactured with 3D-printed molds also describe very good cosmetic results, but an objective quantitative analysis, as performed in the current work by means of volumetry, cannot be found in any of these articles [ 15 , 20 , 22 , 30 ].…”

“…This procedure seems to be particularly suitable for benign lesions and is described in some reports for sphenoorbital meningiomas [ 5 , 10 , 28 ]. However, the relatively high costs of patient-specific implants must be considered, which makes them unlikely to be affordable to a broad majority worldwide [ 15 , 20 ]. Furthermore, due to the typically several weeks required for commercial implant fabrication, this single-step procedure is not feasible for aggressive or malignant lesions, and, in addition, not an option for acute reconstruction after trauma or when intraoperative adjustment of resection margins is required.…”

Custom-Made 3D-Printed Implants for Anterior Column Reconstruction in the Upper Cervical Spine after Intralesional Extracapsular Excision—Report of 2 Cases and Literature Review

“…Other authors [ 10 , 13 , 14 , 16 , 17 ] were reported to have produced more implants of different sizes ranging from 2 [ 14 ] to 32 [ 10 ]. This needs to be taken into consideration in an eventual cost-effectiveness analysis on the use of 3D-printed implants [ 20 , 21 ].…”

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

“…Other authors decided to print a 3D-PLA mold directly, and again, PMMA was used as a cranial prosthesis [ 152 , 153 ]. Similarly, Lannon et al used desktop 3D printers to produce a PLA-made patient-specific mold for a PMMA-made final cranial implant and reported a significant reduction in the total procedure’s expenditure [ 154 ]. None of the mentioned authors experienced any significant complications that would stand out in comparison to the standard cranioplasty methods.…”