Abstract
INTRODUCTION: Decompressive craniectomy is indicated for the treatment of intracranial hypertension in cases of serious traumatic brain injury. This surgery results in a bizarre appearance, as if "part of the head" had been. After regression of cerebral edema and when the patient is in good clinical condition, the reconstruction of the skull is indicated. Reconstruction of the skull can be performed with autologous bone or with alloplastic materials. This study sought to present the experience of the author with skull reconstructions using custom PMMA prostheses.
 METHODS: In between 2014 and 2015, fourteen patients with previous (longer than 6 months) decompressive craniectomies were selected after Neurosurgery medical clearance and underwent skull reconstruction with customized PMMA prototyped prostheses. Signs and symptoms of syndrome of the trephined, computed tomography, and aesthetic appearance of the patients were analyzed preoperatively and at 6 months after reconstruction.
 RESULTS: All patients presented with improved symptomatology, aesthetic improvement and expansion of the brain after surgery.
 CONCLUSION: Reconstruction of the skull with customized prototyped PMMA prostheses improved the signs and symptoms and the aesthetic appearance in all 14 patients of this series. The use of prototypes to customize cranial prostheses facilitates the operative technique and enables patients to develop a nearly normal cranial contour.
Highlights
Decompressive craniectomy is indicated for the treatment of intracranial hypertension in cases of serious traumatic brain injury
The use of customized prototyped prostheses in skull reconstruction has several advantages, including its ability to facilitate the surgical technique[31,32] and the excellent cranial contour that is acquired by the prostheses
Since 2014, with the help of the CTI RA, which has been a unit of the Ministry of Science, Technology and Innovation since 1982 and makes prototypes for SUS patients at no cost, the Hospital da Restauração (HR) Plastic Surgery service started to conduct an alternative method of intraoperative customization with prototyping
Summary
Decompressive craniectomy is indicated for the treatment of intracranial hypertension in severe situations of traumatic brain injury[1,2,3,4]. Of a large part of the frontal, temporal, parietal and/or sphenoid bones of the affected side, thereby allowing the free expansion of cerebral edema without the limitations of the cranial vault This procedure saves lives in many cases, it confers a bizarre appearance to the patient, as if "part of the head" had been removed. In Brazil, it is the alloplastic material that is most often available in the Brazilian public health system (SUS) for skull reconstruction. It consists of a kit with a polymer powder component (30g) and a liquid monomer component (17 ml), which, when mixed, forms an acrylic resin in a polymerization process[20]. Reconstruction of the skull in patients with previous decompressive craniectomy had been performed with intraopeartive manual molding of PMMA into bone defect.
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