3D printed customised external cranial plate in a patient with syndrome of trephined: \u2018a case report\u2019

Mee H.,Sireau S.,Whiting G.,Harkin C.,White PA.,Andrews R.,Anwar F.,Hutchinson PJ.,Price RD.,Timofeev IS.,Greasley S.,Marsden D.,Oliver G.,Helmy A.

doi:10.1186/s41205-021-00123-7

Mee H., Sireau S.

Open Access

https://doi.org/10.1186/s41205-021-00123-7

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Abstract

BackgroundSyndrome of the trephined is a well-recognised phenomenon that occurs in patients following a craniectomy. It is associated with several symptoms, including headaches, motor impairments, cognitive disorders and reduced consciousness. Treatment for the syndrome usually involves replacing the skull defect.Case StudyA 71-year-old male underwent a left-sided craniectomy after being diagnosed with biopsy-confirmed invasive squamous cell carcinoma with associated skull erosion. Subsequently, he developed a severe case of syndrome of the trephined (SoT,) resulting in having to lie flat to prevent the motor component of the Glasgow Coma Score (GCS) falling from M5/6 (E3/4 Vt M5/6) to M1 (E3/4 Vt M1) on sitting to 30 degrees. Unfortunately, due to ongoing chest sepsis and physical frailty, he was unable to undergo a cranioplasty. Therefore, to aid in clinical stabilisation, the treating physicians and clinical engineering teams designed and manufactured a prosthesis on-site, allowing rapid patient treatment. The prosthesis led to the patient being able to sit up to 30 degrees without the motor component of the GCS falling from M6 to M1 (E4 VT M6).ConclusionClinical improvements were demonstrated with definitive neurological improvement after applying the external cranial plate in clinical outcome measures and radiographically. Furthermore, we have shown that rapid prototyping technology provides a flexible solution to synthesise bespoke medical prostheses with the correct expertise and regulatory framework.

Highlights

Decompressive craniectomy is a well-recognised neurosurgical strategy for reducing intracranial pressure, most commonly in the setting of traumatic brain injury and stroke [1], and for invasive malignancy and infection
We have shown that rapid prototyping technology provides a flexible solution to synthesise bespoke medical prostheses with the correct expertise and regulatory framework
(2021) 7:35 titanium alloy by a third-party manufacturer. Both the Trust and the manufacturer deliver this within ISO 13,485 quality management systems, and the plates are classed as custom made medical devices compliant with the Medical Devices Directive (93/42/EEC)

Summary

Conclusion

Clinical improvements were demonstrated with definitive neurological improvement after applying the external cranial plate in clinical outcome measures and radiographically. We have shown that rapid prototyping technology provides a flexible solution to synthesise bespoke medical prostheses with the correct expertise and regulatory framework

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