Cranioplasty with three-dimensional customised mould for polymethylmethacrylate implant: a series of 16 consecutive patients with cost-effectiveness consideration

Erasmo Barros Da Silva Júnior,Marcelo De Paula Loureiro,Caetano Silva Lobo,Rafael Martinelli De Oliveira,Ana Flávia Oliveti,Afonso Henrique De Aragão,Ricardo Ramina

doi:10.1186/s41205-021-00096-7

Erasmo Barros Da Silva Júnior, Marcelo De Paula Loureiro + Show 5 more

Open Access

https://doi.org/10.1186/s41205-021-00096-7

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Abstract

BackgroundDifferent methods of cranioplasty for the reconstruction of bony skull defects exist. In the absence of the autologous bone flap, a customised manufactured implant may be the optimal choice, but this implant has several limitations regarding its technical standardisation and better cost-effectiveness.MethodsThis study presents a series of 16 consecutive patients who had undergone cranioplasty with customised three-dimensional (3D) template moulds for polymethylmethacrylate (PMMA) implants manufactured after 3D modelling on a specific workstation. The virtual images were transformed into a two-piece physical model using a 3D printer for the biomaterials. PMMA implant was produced intraoperatively with the custom mould. Cosmetic results were analysed by comparing pre- and postoperative 3D computed tomography (CT) images and asking if the patient was satisfied with the result.ResultsThe average total time for planning and production of customised mould was 10 days. The 16 patients were satisfied with the result, and CT images presented harmonious symmetry when comparing pre- and postoperative scans. Cases of postoperative infection, bleeding, or reoperation in this series were not observed.ConclusionCranioplasty with high-technology customised 3D moulds for PMMA implants can allow for an aesthetic reconstruction with a fast and cost-effective manufacturing process and possibly with low complication rates.

Highlights

Cranioplasty is a reconstructive surgery that has attracted the attention of doctors and researchers for a long time and is still one of the most commonly performed neurosurgical procedures worldwide
A notable example is the cranioplasty of a Peruvian skull from 2000 BC; the skull was found to have a left frontal defect covered with a 1-mm-thick gold plate
Extensive cranial defects can occur owing to traumatic injuries, infections, congenital or neoplastic diseases, and decompressive craniectomy (DC)

Summary

Introduction

Cranioplasty is a reconstructive surgery that has attracted the attention of doctors and researchers for a long time and is still one of the most commonly performed neurosurgical procedures worldwide. For over 5000 years, surgeons have been trying to determine a suitable material for the proper repair of cranial defects. The material used for the repair directly reflected the patient’s social level. This incessant search for a perfect material that provides a good functional and aesthetic result is observed even today [1]. Extensive cranial defects can occur owing to traumatic injuries, infections, congenital or neoplastic diseases, and decompressive craniectomy (DC). Cranioplasty restores the cosmetic form of the cranium to avoid post-craniectomy complications such as seizures, syndrome of the trephined, and brain herniation through the defect [2, 3]. Different methods of cranioplasty for the reconstruction of bony skull defects exist. In the absence of the autologous bone flap, a customised manufactured implant may be the optimal choice, but this implant has several limitations regarding its technical standardisation and better cost-effectiveness

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