Cranioplasty is a commonly performed procedure. Outcomes can be improved by the use of patient specific implants, however, high costs limit their accessibility. This paper presents a low cost alternative technique to create patient specific polymethylmethacrylate (PMMA) implants using rapid prototyped mold template. We used available patient's CT-scans, one dataset without craniotomy and one with craniotomy, for computer-assisted design of a 3D mold template, which itself can be brought into the operating room and be used for fast and easy building of a PMMA implant. We applied our solution to three patients with positive outcomes and no complications.
"Yöntem 3 hasta üzerinde denenmiş ve ikisinde mükemmel estetik sonuçlar elde edilmiştir. 1 hastanın şakak kasları atrofik 2 olması sebebiyle asimetrik bir görüntü elde edilmiştir. Ancak hiçbir hastada enfeksiyon görülmemiştir . "
[Show abstract][Hide abstract] ABSTRACT: Cranioplasty is a surgical operation to repair hole or defects on skull. 3 dimensional computed tomography (CT) images are used for automatic determination of the shape of implant which is used for repairing defect. The designing implant by mathematical model and manufacturing it before operation lowers the operation cost. In this paper, previous studies are examined, applications are realized by radial basis functions (RBF) and insufficient sections of previous studies are revealed.
Signal Processing and Communications Applications Conference (SIU), Trabzon, Turkey; 04/2014
"CAD/CAM technology has been used successfully to make PMMA implants as well. 3D models of cranial implants were designed from CT scan DICOM data and 3D printing technology is used to produce mold templates of the proposed implant, which was then used intraoperatively to quickly make the implant in the operatory. Similarly, CT scan data was used to create an implant digital model and RP to produce silicon molds which were then used for creating patient specific cranial implant. "
[Show abstract][Hide abstract] ABSTRACT: Custom implants for the reconstruction of craniofacial defects have gained importance due to better performance over their generic counterparts. This is due to the precise adaptation to the region of implantation, reduced surgical times and better cosmesis. Application of 3D modeling in craniofacial surgery is changing the way surgeons are planning surgeries and graphic designers are designing custom implants. Advances in manufacturing processes and ushering of additive manufacturing for direct production of implants has eliminated the constraints of shape, size and internal structure and mechanical properties making it possible for the fabrication of implants that conform to the physical and mechanical requirements of the region of implantation. This article will review recent trends in 3D modeling and custom implants in craniofacial reconstruction.
"Prefabrication of PMMA prostheses by hand has been used since the 1970s employing various procedures, but these methods appear to have been shadowed by newer computer-aided design and computer-aided manufacturing (CAD/CAM) techniques, which basically consist of using imaging from the patients’ cranial defect and prefabricating the PMMA prosthesis using a 3-D printer. Unfortunately, the use of these techniques becomes a challenge for developing and third-world countries, in which limited economic and logistical resources do not allow for the extensive use of such technology. "
[Show abstract][Hide abstract] ABSTRACT: Decompressive craniectomies (DC) mandate future cranioplasties, accounting for the large array of biomaterials for this purpose. Polymethylmethacrylate (PMMA) is a very reliable thermoplastic that can be prefabricated or even molded intraoperatively to create an adequate prosthesis. Preformed PMMA implants made by hand have been superseded by newer 3-D printed implants, but this is accompanied by higher costs and timing issues, apart from having limited availability in developing and third-world countries.
A total of 26 patients were operated over a span of 11 years. A total of 26 custom hand-made PMMA prostheses were fabricated using original bone flaps with the aid of a prosthodontist, in a process that took approximately 70 minutes for each implant. The result was an exact duplication of the patient's bone flap.
Of the 26 patients who underwent cranioplasty, the majority of patients were males, with a mean age of 39.2 years and traumatic brain injury as main indication for DC. After a mean interval of 2.4 months, all 26 patients underwent a cranioplasty and prosthesis placement. Only two patients (7.6%) suffered from direct cranioplasty-related complications after a median follow-up of 10.4 months. Median Glasgow Outcome Scale scores improved significantly from 3 to 4 after cranioplasty (P = 0.008).
Prefabrication of custom PMMA prostheses by hand when original bone flaps are available is an excellent alternative to newer 3-D printing techniques, because it is relatively cheaper, less time consuming, and offers excellent results in terms of anatomical reconstruction and improvement of neurological function in long-term follow-ups.
Surgical Neurology International 10/2013; 4(1):136. DOI:10.4103/2152-7806.119535 · 1.18 Impact Factor
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