Abstract
Problem statement: Cranioplasty is defined as a neurosurgical procedure to cover an injured bone in the skull. This procedure is carried out in order to protect and restore intracranial structures and to restore the appearance and psychological stability of the patient. Advances in medical imaging, such as MRI and CT, have allowed the 3D reconstruction of anatomical structures for several medical applications, including the design of custom-made implants. This study describes the methodology used to design a custom-made cranial implant for a 13-year-old patient who suffered a lesion in the left frontoparietal region of the skull caused by a fall. Approach: The design of the implant was based on the 3D reconstruction of the skull of the patient, obtained by a CT scan, using Rapid Form® 2006. Once the preliminary design was completed, 3D models of the injured region of the skull and of the implant were fabricated in a Rapid Prototyping (RP) machine using Fused Deposition Modeling Technology (FDM) with the purpose of functionally and dimensionally validating the implant. Subsequently, the implant was fabricated using a 1.2-mm-thick Titanium Alloy (Ti6Al4V) plate. Results: The prosthesis was successfully implanted. The surgical time was 85% shorter than that for the same type of surgery in which standard commercial implants and titanium meshes are used. This decrease in surgery time is primarily the result of eliminating the need for trial and error procedures to achieve a good fit for the implant. Finally, the appearance of the patient was restored, allowing the patient to safely perform daily activities. Conclusion: The use of 3D reconstruction techniques from medical images reduces the possibility of errors during surgery, improves fit and provides better implant stability. The use of 3D models designed in RP proved to be an effective practice in the design process.
Highlights
Cranioplasty is defined as a neurosurgical procedure to cover an injured bone in the skull
The entire implantation process lasted about 45 min the surgery time was reduced by 85% compared with surgeries in which commercial implants and titanium meshes were used
A custom-made cranial implant was designed, fabricated and placed into a patient whose brain was only protected by the meninges and the scalp after a 1.6 m fall
Summary
Cranioplasty is defined as a neurosurgical procedure to cover an injured bone in the skull Such injuries can be caused by congenital defects, diseases, accidents, infections or tumors. In the case of cranial implants, several studies have reported the advantages of using different computer-aided design and advance manufacturing platforms (CAD/CAM) (Drstvensek et al, 2008). These advantages are reflected in the better fit of the implant, a decrease in the surgery time and better esthetic results (Joffe et al, 1992; Eufinger et al, 1995; Heissler et al, 1998; Mazzoli et al, 2009) compared with manual methods. The injury was located in the left half (Fig. 4)
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