Polylactic Acid Implant for Cranioplasty with 3-dimensional Printing Customization: A Case Report

Abstract

BACKGROUND: Cranioplasty is aimed to restore the structure and function of the lost portion of the skull defect. Many materials can be used for cranioplasty, such as the bones of the patient (autograft), the bones of other patients (allograft), bones of animals (xenograft), or synthetic materials such as acrylic or titanium mesh. These materials are quite expensive and sometimes require complex processes. Manual shaping of material for cranioplasty is also quite time-consuming and prone to cause esthetic dissatisfaction. The author will discuss the case of using polylactic acid (PLA) implant with 3-dimensional (3D) printing customization as a cheap and accurate cosmetic solution for cranioplasty procedures.
 CASE REPORT: We report 2 cases of skull defect underwent cranioplasty. The first case, female, 20-year-old, had a history of severe traumatic brain injury (TBI) and epidural hematoma. She underwent decompression craniotomy on the left frontotemporoparietal region of her skull. The second case, male, 46-year-old, had a history of spontaneous intracerebral hemorrhage due to arteriovenous malformation (AVM). He underwent decompression craniotomy on the right frontotemporoparietal region of her skull. Both the data of computerized tomography (CT) scan were reconstructed to get 3D model of skull defect. Prosthesis was made by 3D printer accordingly using PLA as material. There was no complication reported postoperatively and cosmetic satisfaction was obtained on both cases.
 CONCLUSION: The use of PLA implant with 3D printing customization was proved to be cost-effective and good cosmetic satisfaction with no complication reported following cranioplasty procedure.

A Single Standard Polyvinyl Chloride 3D Skull Model to Create the Polymethyl Methacrylate Cranioplasty Flap: A Novel and Low-Cost Technique

“…The cost of prefabricated hydroxyapatite, PEEK, and titanium implants ranges from US$7,000 to 11,000 (►Table 5). [22][23][24] The costs of customized PMMA (computer-aided design/computer-aided manufacturing [CAD/CAM] version) and acrylonitrile butadiene styrene (ABS) implants are much higher than the cost of the PMMA implant used in this study. 22,25 The total cost incurred using our technique was approximately US$200, including all materials required for surgery, postoperative medication, investigations and hospital charges.…”

State-of-Art of Standard and Innovative Materials Used in Cranioplasty

“…The mechanical performance, as the tensile strength (about 30% of the strength of bone, which is about 82 MPa, as reported in the literature [ 49 ], remains near 100% at 3 months of implantation, decreasing at 90, 70, 50 and 0% at respectively 6, 9, 12 and 18 months of implantation [ 48 ]. Three-dimensional printing technology could also be used as a solution for cranioplasty procedure [ 50 ].…”

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

“…In Macedonia, Apriawan et al implemented PLA as a material for the cranioplasty of two patients following decompressive craniectomies. In both cases, no postoperative complications have been recorded [ 155 ]. A simulation of cranial reconstruction with a use of PLA is presented in Chart 5 below.…”

“…The 3D-printing market offers an abundance of materials, with the simplest Poly(lactic acid) filament for as low as USD 20 per 1 kg, with an average cost for the 3D-printed craniofacial models ranging from USD 20 to 100. In a study conducted by Apriawan et al, the PLA cost for a 3D-cranioplasty model reached around USD 50–150 [ 155 ]. A PLA-made-cranial model for surgical consulting purposes costs around USD 5.20 [ 230 ].…”

“…In a study by Unterhofer et al, conducted on 46 patients, the expenditure of PMMA-implant production oscillated around EUR 81 [ 120 ]. For comparison, the manufactured personalized PEEK implants cost around USD 10,450, titanium implants cost USD 10,265 and HA is USD 7849–8960 [ 60 , 155 ] ( Table 3 ).…”