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      Considerations in computer-aided design for inlay cranioplasty: technical note

      research-article
      Author(s): 1 , 2 , 1 ,
      Publication date (Electronic):
      Journal: Oral and Maxillofacial Surgery
      Publisher: Springer Berlin Heidelberg
      Keywords: Cranium, Implant, Computer-aided design

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          Abstract

          Context

          Cranioplasty is a frequently performed procedure that uses a variety of reconstruction materials and techniques. In this technical note, we present refinements of computer-aided design–computer-aided manufacturing inlay cranioplasty.

          Objective, design, and setting

          In an attempt to decrease complications related to polyether-ether-ketone (PEEK) cranioplasty, we gradually made changes to implant design and cranioplasty techniques. These changes include under-contouring of the implant and the use of segmented plates for large defects, microplate fixation for small temporal defects, temporal shell implants to reconstruct the temporalis muscle, and perforations to facilitate the drainage of blood and cerebrospinal fluid and serve as fixation points.

          Results

          From June 2016 to June 2017, 18 patients underwent cranioplasty, and a total of 31 PEEK and titanium implants were inserted. All implants were successful.

          Conclusions

          These changes to implant design and cranioplasty techniques facilitate the insertion and fixation of patient-specific cranial implants and improve esthetic outcomes.

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          Long-term results following titanium cranioplasty of large skull defects.

          Mario Cabraja, Martin Klein, Thomas-Nikolas Lehmann (2009)
          Decompressive craniectomy is an established procedure to lower intracranial pressure. Therefore, cranioplasty remains a necessity in neurosurgery as well. If the patient's own bone flap is not available, the surgeon can choose between various alloplast grafts. A review of the literature proves that 4-13.8% of polymethylmethacrylate plates and 2.6-10% of hydroxyapatite-based implants require replacement. In this retrospective study of large skull defects, the authors compared computer-assisted design/computer-assisted modeled (CAD/CAM) titanium implants for cranioplasty with other frequently used materials described in literature. Twenty-six patients underwent cranioplasty with CAD/CAM titanium implants (mean diameter 112 mm). With the aid of visual analog scales, the patients' pain and cosmesis were evaluated 6-12 years (mean 8.1 years) after insertion of the implants. None of the implants had to be removed. Of all patients, 68% declared their outcomes as excellent, 24% as good, 0.8% as fair, and 0% as poor. There was no resulting pain in 84% of the patients, and 88% were satisfied with the cosmetic result, noting > 75 mm on the visual analog scale of cosmesis. All patients would have chosen cranioplasty again, stating an improvement in their quality of life by the calvarial reconstruction. Nevertheless, follow-up images obtained in 4 patients undergoing removal of meningiomas was only suboptimal. With the aid of CAD technology, all currently used alloplastic materials are suited even for large skull defect cranioplasty. Analysis of the authors' data and the literature shows that cranioplasty with CAD/CAM titanium implants provides the lowest rate of complications, reasonable costs, and acceptable postoperative imaging. Polymethylmethacrylate is suited for primary cranioplasty or for long-term follow-up imaging of tumors. Titanium implants seem to be the material of choice for secondary cranioplasty of large skull defects resulting from decompressive craniectomy after trauma or infarction. Expensive HA-based ceramics show no obvious advantage over titanium or PMMA.
          Article 0 comments Cited 49 times – based on 0 reviews     Review now
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            Long-term clinical outcome analysis of poly-methyl-methacrylate cranioplasty for large skull defects.

            Joby E Jaberi, Michael Madden, Kenneth Gambrell … (2013)
            The goal of secondary cranioplasty is permanent cerebral protection in an esthetically acceptable fashion. Reconstruction of cranial defects can be performed with several different materials. Alloplastic materials, such as preformed methyl-methacrylate (PMMA) cranioplasties, are an alternative frequently used at our institution. This retrospective analysis was designed to review the outcomes of PMMA cranioplasty for skull defect reconstruction. Seventy consecutive patients who had 78 PMMA cranioplasties placed from 2003 through 2010 were identified. Mechanism of injury, location of cranioplasty, type of original repair, postoperative complications, and follow-up time were reviewed. Of the 70 patients, 6 patients had failure and removal of their original PMMA cranioplasty and reinsertion of another, and 2 patients had failure and removal of 2 cranioplasties with replacement of a third, creating a total of 78 PMMA cranioplasties placed. The predominant mechanism of injury was trauma (64%). The most frequent postoperative complication was infection (13%). With the exception of the 2 patients with implant exposure, no patients reported an unacceptable cosmetic result. An overall complication rate of 24% was seen. The results of previous studies have shown that infection and complication rates of cranioplasties accomplished with bone cement are substantially higher, that titanium-based implants may obscure follow-up imaging for tumor patients, and that the outcomes regarding hydroxyapatite-based ceramics, although similar to PMMA, are associated with a much higher cost. PMMA remains a cost-effective and proven method to repair cranial defects that fulfills the goals of cranial reconstruction for skull defects. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. All rights reserved.
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              Syndrome of the trephined.

              Peter Reilly, Vivek Joseph (2009)
              "Syndrome of the trephined" or "sinking skin flap syndrome" is an unusual syndrome in which neurological deterioration occurs following removal of a large skull bone flap. The neurological status of the patient can occasionally be strongly related to posture. A 77-year-old male patient with an acute subdural hematoma was treated using a hemicraniectomy and evacuation of the hematoma. On the 9th postoperative day there was deterioration in sensorium associated with a sunken scalp flap and worsening midline shift on CT. A significant improvement in sensorium and a filling up of the scalp flap occurred after maintaining the patient's head in a dependent position. The patient subsequently made an excellent recovery following replacement of the bone flap. The pathophysiology of "syndrome of the trephined" or "sinking skin flap syndrome" is reviewed.
              Article 0 comments Cited 21 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Erik Nout: e.nout@etz.nl
                Maurice Y. Mommaerts: maurice.mommaerts@uzbrussel.be
                Journal
                Journal ID (nlm-ta): Oral Maxillofac Surg
                Journal ID (iso-abbrev): Oral Maxillofac Surg
                Title: Oral and Maxillofacial Surgery
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 1865-1550
                ISSN (Electronic): 1865-1569
                Publication date (Electronic): 8 January 2018
                Publication date PMC-release: 8 January 2018
                Publication date (Print): 2018
                Volume: 22
                Issue: 1
                Pages: 65-69
                Affiliations
                [1 ]European Face Centre, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
                [2 ]Division of Oro-Maxillo-Facial Surgery, GH Elisabeth-Tweesteden, Tilburg, The Netherlands
                Article
                Publisher ID: 668
                DOI: 10.1007/s10006-017-0668-4
                PMC ID: 5820390
                PubMed ID: 29313149
                SO-VID: 7c361ea7-c51a-4256-8185-1c76b1f4f36a
                Copyright © © The Author(s) 2018
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 10 August 2017
                Date accepted : 28 December 2017
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2018

                ScienceOpen disciplines: Surgery
                Keywords: cranium,implant,computer-aided design
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: cranium, implant, computer-aided design

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