Long-Term Clinical Outcome Analysis of Poly-Methyl-Methacrylate Cranioplasty for Large Skull Defects

Jaberi, J.; Gambrell, Kenneth; Tiwana, Paul S.; Madden, Christopher; Finn, Richard A.

doi:10.1016/j.joms.2012.09.023

Cited by 121 publications

(88 citation statements)

References 26 publications

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“…Mold fabrication techniques that require an intact bone flap 3,10,57 cannot be used when the original bone flap is not available. The method of mold production by direct casting of the defect on the patient's head 2,25,50 is inaccurate due to the presence of soft tissue and the absence of the normal calvarial curvature. These factors explain our choice to design the mold based on the patient's intact contralateral skull by the use of computer 3D modeling techniques based on high-resolution CT scan data.…”

Section: Discussionmentioning

confidence: 99%

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

Tan¹,

Ling²,

Dinesh³

2016

JNS

104

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T he reconstruction of a skull vault defect, termed cranioplasty, has a rich and fascinating history. For at least 5 millennia, surgeons have patched cranial defects with an immensely diverse range of materials ranging from fruit shells to sheep scapulae and man-made plastics. 42 Even today, the pursuit of the perfect cranioplasty material and technique continues.Skull defects are often the direct result of surgical decompressive craniectomy performed for acute neurosurgical emergencies. 23 The use of a patient's original bone flap for cranioplasty is theoretically sound and avoids the problems related to the use of bone from other sources, such as human cadavers (allografts) or animals (xenografts), or the use of synthetic materials. In practice, however, cranioplasty using these bone flaps, which have been stored for a period of time either in a surgically created subcutaneous pocket or in a medical freezer, is plagued with a not insignificant risk of infections and bony resorption. 8,11,22 With unnatural storage, the nature and content of these bone flaps are changed permanently, hindering successful reincorporation as part of the skull vault. Loss of osteogenesis probably plays a role; studies on human calvarial bone flaps have shown a diminution of osteoblasts after both subcutaneous 44 The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer eddie t. w. tan, mrcsed, Ji min ling, mrcsed, and shree Kumar dinesh, FrcsDepartment of Neurosurgery, National Neuroscience Institute, Singapore obJective Commercially available, preformed patient-specific cranioplasty implants are anatomically accurate but costly. Acrylic bone cement is a commonly used alternative. However, the manual shaping of the bone cement is difficult and may not lead to a satisfactory implant in some cases. The object of this study was to determine the feasibility of fabricating molds using a commercial low-cost 3D printer for the purpose of producing patient-specific acrylic cranioplasty implants. methods Using data from a high-resolution brain CT scan of a patient with a calvarial defect posthemicraniectomy, a skull phantom and a mold were generated with computer software and fabricated with the 3D printer using the fused deposition modeling method. The mold was used as a template to shape the acrylic implant, which was formed via a polymerization reaction. The resulting implant was fitted to the skull phantom and the cranial index of symmetry was determined. results The skull phantom and mold were successfully fabricated with the 3D printer. The application of acrylic bone cement to the mold was simple and straightforward. The resulting implant did not require further adjustment or drilling prior to being fitted to the skull phantom. The cranial index of symmetry was 96.2% (the cranial index of symmetry is 100% for a perfectly symmetrical skull). coNclusioNs This study showed that it is feasible to produce patient-specific acrylic cranioplasty implants with a low-cost 3D printer. Further studies...

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Section: Discussionmentioning

confidence: 99%

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

Tan¹,

Ling²,

Dinesh³

2016

JNS

104

View full text Add to dashboard Cite

show abstract

“…It finds common use as a grout-like-material or for lost bone remodeling [24,25,28,71,72]. Whilst PMMA is a biocompatible material, the raw methyl methacrylate component is a potential irritant [73].…”

Section: Discussionmentioning

confidence: 99%

“…As such, the ISF ranking assigned to PMMA is 1. PMMA is a bioinert material and is shown to have very little natural support for attachment and ingrowth of tissue [32], however small holes may be bored into the implant to provide pathways for tissue growth [24]. Whilst these holes can allow some tissue connection through the implant, they are not considered to be an extensive and integral component of the PMMA implant.…”

Section: Pmma (Templated)mentioning

confidence: 99%

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

et al. 2017

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Background: Analysis of current literature highlights a wide variation in reported infection risk for different materials in cranial repair. The purpose of these composite materials are to mimic natural bone and assist in restoring function (structurally and aesthetically) to the human skull. This review aims to examine the meta-data in order to provide an amalgamated overview of potential trends between implant material, manufacturing method and infection risk, in order to provide a core reference point for future studies surrounding emerging biomedical materials in the fields of cranioplasty by providing base point for understanding the capabilities and limitations of current technologies. Methods: A search for articles was conducted, with the following criteria seen as fundamental in providing an accurate picture of the current landscape: publication in the last decade, provision of a numerical value for both number of implants and infection cases, patient sample of 10+, adult patients, and cranioplasty/cranial repair. Results: A total of 41 articles were seen to meet the author's inclusion criteria. Average infection rates per material ranged between 2.04% and 10.98%. The results indicate that there is variation between materials in regards to total infection risk, however, depending on the materials compared, this value may be insignificant. Alternative risk factors associated with infection, including surgical time, revisions and previous infection, have a greater impact on infection potential than material variation. Comparison of fabrication methods did highlight a notable effect on average infection rate. Trends can be observed showing that materials with greater levels of surface interaction and active support of tissue ingrowth presented greater infection resistance. Such characteristics are due to the physical structures of the implants. Conclusions: It can be said that the manufacturing methods can influence biomedical materials to assist in minimizing implant infection risk.

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“…Beside metallic materials, bio-ceramics and ceramic coatings have been extensively adopted in the last years [4]: hydroxyapatite is one of the most diffused due to its properties which are very similar to bone's ones, thus promoting the body integration of the implant [5]. Actually, a promising alternative to the above mentioned materials is represented by the adoption of polymers for prosthetic implants: methyl-methacrylate, being costeffective and reducing the occurrence of intoxication, is widely adopted in cranioplasty [6]. On the other hand, the proper selection of the manufacturing process is a key point: stereolitography, as well as the CAD/CAM approach, is widely adopted since it facilitates, speeds up and improves the quality of surgical procedures [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Biomedical Titanium alloy prostheses manufacturing by means of Superplastic and Incremental Forming processes

et al. 2016

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Abstract. The present work collects some results of the three-years Research Program "BioForming", funded by the Italian Ministry of Education (MIUR) and aimed to investigate the possibility of using flexible sheet forming processes, i.e. Super Plastic Forming (SPF) and Single Point Incremental Forming (SPIF), for the manufacturing of patient-oriented titanium prostheses. The prosthetic implants used as case studies were from the skull; in particular, two different Ti alloys and geometries were considered: one to be produced in Ti-Gr23 by SPF and one to be produced in Ti-Gr2 by SPIF. Numerical simulations implementing material behaviours evaluated by characterization tests were conducted in order to design both the manufacturing processes. Subsequently, experimental tests were carried out implementing numerical results in terms of: (i) gas pressure profile able to determine a constant (and optimal) strain rate during the SPF process; (ii) tool path able to avoid rupture during the SPIF process. Post forming characteristics of the prostheses in terms of thickness distributions were measured and compared to data from simulations for validation purposes. A good correlation between numerical and experimental thickness distributions has been obtained; in addition, the possibility of successfully adopting both the SPF and the SPIF processes for the manufacturing of prostheses has been demonstrated.

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Long-Term Clinical Outcome Analysis of Poly-Methyl-Methacrylate Cranioplasty for Large Skull Defects

Cited by 121 publications

References 26 publications

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

Biomedical Titanium alloy prostheses manufacturing by means of Superplastic and Incremental Forming processes

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