Customized polymethylmethacrylate cranioplasty using a low-cost 3-dimensional printed mold

Abstract

Introduction. Significant cranial defects result from a decompressive craniectomy following head trauma, malignant brain edema, intracranial hemorrhage, or resection of tumor affected bone. Unrepaired cranial defects are not just a tremendous esthetic problem. The underlying brain is unprotected, prone to injury, and this state can lead to the so-called ?syndrome of the trephined? with mood instability, headaches, and even a neurological deficit. Currently, there is no widely accepted uniform technique of cranial vault shape restoration. Combining 3D technology with the use of polymethylmethacrylate is a challenging field that can bring good functional and aesthetic results and, in the case of smart design, become efficient, low-cost technology. We offer a possible solution to a problem that would be acceptable in neurosurgical practice. Case outline. We present a 37-year-old male patient with a massive hemicranial defect as a consequence of previous decompressive craniectomy following severe craniocerebral injury the previous year. Together with engineers from the appropriate 3D modeling studio, we have designed a two-part mold by laser printing technology using biocompatible advanced polyamide. We made a customized polymethylmethacrylate graft intraoperatively using this mold and achieved good aesthetic results. Conclusion. Reports of 3D printing assisted cranioplasties are growing, describing different techniques and cost- estimation. We hope to introduce a low-cost and simple method for repairing a skull defect.