Schedule feasibility and workflow for additive manufacturing of titanium plates for cranioplasty in canine skull tumors

Abstract

Background: Additive manufacturing has allowed for the creation of a patient-specific custom solution that can resolve many of the limitations previously reported for canine cranioplasty. The purpose of this pilot study was to determine the schedule feasibility and workflow in manufacturing patient-specific titanium implants for canines undergoing cranioplasty immediately following craniectomy. Results: Computed tomography scans from patients with tumors of the skull were considered and 3 cases were selected. Images were imported into a DICOM image processing software and tumor margins were determined based on agreement between a board-certified veterinary radiologist and veterinary surgical oncologist. Virtual surgical planning was performed and a bone safety margin was selected. A defect was created to simulate the planned intraoperative defect. Stereolithography format files of the skulls were then imported into a plate design software. In collaboration with a medical solution centre, a custom titanium plate was designed with the input of an applications engineer and veterinary surgery oncologist. Plates were printed in titanium and post-processed at the solution centre. Total planning time was approximately 2 h with a manufacturing time of 2 weeks. Conclusions: Based on the findings of this study, with access to an advanced 3D metal printing medical solution centre that can provide advanced software and printing, patient-specific additive manufactured titanium implants can be planned, created, processed, shipped and sterilized for patient use within a 3-week turnaround.

Occipital cranioplasty using customized titanium prosthesis yields successful outcome in association with foramen magnum decompression in dogs suffering by Chiari-like malformation

“…First, the customized implant does not require intraoperative implant molding, reducing surgical time and consequently the risk of infection. 22,[24][25][26][27] Second, the implant was designed using the 3-D model of the patient's skull, to match the shape of the calvarium and perfectly cover the bone defect. Furthermore, the design of the prosthesis allowed the surgeon to insert the screws in the thickest bone, ensuring that the implant would maintain its position and remain stable during the postoperative period as well as avoiding potential harm to the underlying neural structures.…”

“…17,18,20 The use of a customized titanium prosthesis has been previously described in veterinary literature concerning restoration of skull anatomy after removal of bony tumors. 21,22 To the authors' knowledge, no previous reports exist of CM-SM in dogs treated with FMD and occipital cranioplasty using customized titanium prostheses. Therefore, the purposes of the present study were to describe the use of a customized cranioplasty implant for the treatment of CM in dogs, assuming it may help in medium-to long-term outcomes by minimizing the risk of relapses, to analyze the feasibility of this type of implant, and to report outcomes of implant use in a specific group of dogs.…”

Applications of 3‐dimensional printing in small‐animal surgery: A review of current practices

“…Threedimensional printed titanium plates have also been used for cranioplasty in 3 dogs with skull tumors. 82 The authors felt that this approach reduced the duration of surgery and improved cosmetic results over standard titanium plates. However, they noted the importance of accurately delineating the extent of the tumor on preoperative CT and recommended printing patient-specific cutting guides to ensure that the resection matched the implant.…”

“…33 Three-dimensional printed titanium plates used for cranioplasty in three dogs required 2 h of planning and 2 weeks of manufacturing, allowing surgery within 3 weeks of preoperative imaging. 82 The delay and cost associated with the use of patient-specific guides and implants must be weighed against reduction in surgical time, anesthesia cost, and infection rates in future studies.…”

Prototipagem rápida na medicina veterinária: Revisão

“…Na medicina veterinária, seu uso pode vir a revolucionar, tanto a área acadêmica, quanto a área clínico cirúrgica, possibilitando a criação de modelos anatômicos para treinamento e capacitação de profissionais e a fabricação customizada de próteses e implantes para auxílio em cirurgias ortopédicas, podendo contribuir para a redução do tempo do procedimento e acelerar a cicatrização do paciente (James et al, 2020;Matozinhos et al, 2017). Além destas, a prototipagem rápida torna possível a bioimpressão, que utiliza células e outros biomateriais na produção de tecidos e órgãos (Jamieson et al, 2021).…”