Reconstruction of large cranial defects with poly-methyl-methacrylate (PMMA) using a rapid prototyping model and a new technique for intraoperative implant modeling

Unterhofer, Claudia; Wipplinger, Christoph; Verius, Michael; Recheis, Wolfgang; Thomé, Claudius; Ortler, Martin

doi:10.1016/j.pjnns.2017.02.007

Cited by 47 publications

(40 citation statements)

References 35 publications

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“…18 Advantages of computer-designed, prefabricated implants have been demonstrated and include improved cosmetic outcome as well as minimization of the procedure time needed for implant insertion. 16 However, in most series, expensive commercial and industrial 3D printers (approximately US$37,000-US$310,000) or expensive com-mercial implants (approximately US$10,000) 3,5,8,13,18,21,22,26,[30][31][32] were used, which are prohibitive for use in low-and middle-income countries.…”

Section: Discussionmentioning

confidence: 99%

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Morales-Gómez¹,

Garcia-Estrada²,

Leos-Bortoni³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Cranioplasty implants should be widely available, low in cost, and customized or easy to mold during surgery. Although autologous bone remains the first choice for repair, it cannot always be used due to infection, fragmentation, bone resorption, or other causes, which led to use of synthetic alternatives. The most frequently used allogenic material for cranial reconstructions with long-term results is polymethylmethacrylate (PMMA). Three-dimensional printing technology has allowed the production of increasingly popular customized, prefabricated implants. The authors describe their method and experience with a customized PMMA prosthesis using a precise and reliable low-cost implant that can be customized at any institution with open-source or low-cost software and desktop 3D printers. METHODS A review of 22 consecutive patients undergoing CT-based, low-cost, customized PMMA cranioplasty over a 1-year period at a university teaching hospital was performed. Preoperative data included patient sex and age; CT modeling parameters, including the surface area of the implant (defect); reason for craniectomy; date(s) of injury and/or resections; the complexity of the defect; and associated comorbidities. Postoperative data included morbiditiy and complications, such as implant exposure, infection, hematoma, seroma, implant failure, and seizures; the cost of the implant; and cosmetic outcome. RESULTS Indications for the primary craniectomy were traumatic brain injury (16, 73%), tumor resection (3, 14%), infection (1, 4%), and vascular (2, 9%). The median interval between previous surgery and PMMA cranioplasty was 12 months. The operation time ranged from 90 to 150 minutes (mean 126 minutes). The average cranial defect measured 65.16 cm (range 29.31-131.06 cm). During the recovery period, there was no sign of infection, implant rejection, or wound dehiscence, and none of the implants had to be removed over a follow-up ranging from 1 to 6 months. The aesthetic appearance of all patients was significantly improved, and the implant fit was excellent. CONCLUSIONS The use of a customized PMMA was associated with excellent patient, family, and surgeon satisfaction at follow-up at a fraction of the cost associated with commercially available implants. This technique could be an attractive option to all patients undergoing cranioplasty.

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Section: Discussionmentioning

confidence: 99%

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Morales-Gómez¹,

Garcia-Estrada²,

Leos-Bortoni³

et al. 2019

Journal of Neurosurgery

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“…Cranioplasty with the use of PMMA is a method that has been increasingly consolidated in neurosurgical practice. [1137] Since the 1940s, this has been the most commonly used material for secondary cranial reconstruction. [42] PMMA consists of a thermoplastic material with high biocompatibility, mechanical resistance, and wide use in the medical environment.…”

Section: Discussionmentioning

confidence: 99%

Functional and aesthetic evaluation after cranial reconstruction with polymethyl methacrylate prostheses using low-cost 3D printing templates in patients with cranial defects secondary to decompressive craniectomies: A prospective study

et al. 2019

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Background:Cranial reconstruction surgery is a procedure used as an attempt to reestablish the cranial bone anatomy. This study evaluates the symptomatic and aesthetic improvement of patients with cranial defects secondary to decompressive craniectomies after cranial reconstruction with customized polymethyl methacrylate (PMMA) prostheses. Secondly, we aim to divide our experience in the production of these prostheses with a low-cost method.Methods:A prospective study was carried out with patients submitted to cranioplasty at the Hospital da Restauração between 2014 and 2017. A total of 63 cranioplasties were performed using customized PMMA prosthesis produced by 3D impression molds. All patients underwent a functional and aesthetic evaluation questionnaire in the preoperative period and in the sixth postoperative month.Results:Sixty-three patients underwent cranioplasty with a mean age of 33 years, ranging from 13 to 58 years, 55 males and 8 females. The mean area of the defect was 147 cm2. The mean postoperative follow-up of the patients was 21 months, ranging from 6 to 33 months. Fifty-five patients attended the 6-month postoperative consultation. All patients presented symptomatic improvement after reconstruction of the skull. The infection rate was 3.2%, 4.8% of extrusion, 1.6% of prosthesis fracture, 7.9% of extradural hematoma, 17.4% of reoperation, 5% of wound dehiscence, and 4.8% of removal of the prosthesis.Conclusion:Cranioplasty, with a customized PMMA prosthesis, improved the symptoms and aesthetic appearance of all operated patients. The use of prototypes to customize cranial prostheses facilitated the operative technique and allowed the recovery of a cranial contour very close to normal.

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“…The use of rotating instruments for finishing of the PMMA prosthesis intraoperatively is thought to increase the risk of contamination of the operative field. The intraoperative technique has been used for a long time, it does not add costs to the procedure, it is safe, presents good clinical results and low complication rates [ 4 , 12 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Labial repositioning using polymethylmethracylate (PMMA)-based cement for esthetic smile rehabilitation—A case report

Arcuri

Costa²,

Ribeiro

et al. 2018

International Journal of Surgery Case Reports

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Reconstruction of large cranial defects with poly-methyl-methacrylate (PMMA) using a rapid prototyping model and a new technique for intraoperative implant modeling

Abstract: PMMA implants fabricated in-house by direct molding using a bio-model of the patients bony head are easily produced, fit properly and are inexpensive compared to cranial implants fabricated with other RP or milling techniques.

Cited by 47 publications

References 35 publications

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Functional and aesthetic evaluation after cranial reconstruction with polymethyl methacrylate prostheses using low-cost 3D printing templates in patients with cranial defects secondary to decompressive craniectomies: A prospective study

Labial repositioning using polymethylmethracylate (PMMA)-based cement for esthetic smile rehabilitation—A case report

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