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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/s-0044-1785648
Original Article

A Single Standard Polyvinyl Chloride 3D Skull Model to Create the Polymethyl Methacrylate Cranioplasty Flap: A Novel and Low-Cost Technique

Hanuman Prasad Prajapati
1   Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
,
Deepak Kumar Singh
2   Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
› Author Affiliations Funding None.
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Abstract

Background Although, cranioplasty is a commonly performed neurosurgical procedure worldwide, the cost of available cranioplasty implants is a major issue in a low-income country like India. The aims of this study were to introduce a novel and low-cost technique using a single standard three-dimensional (3D) skull model to guide the polymethyl methacrylate (PMMA) cranioplasty flap production and to evaluate the functional and cosmetic outcomes.

Methods We retrospectively evaluated 47 cases of PMMA cranioplasty in the period from February 2019 to June 2022. A single standard 3D skull model was used to make the PMMA cranioplasty flaps. The overall cost of this PMMA implant was compared with that of other available cranioplasty implants. The functional and cosmetic outcomes were evaluated postoperatively.

Results The mean age of our patients was 37.17 ± 13.83 years and the age range was 17 to 63 years. The primary cause of surgery was trauma in the majority of cases (n = 31, 65.96%). The mean operative time was 78.55 ± 19.82 minutes. The cosmetic results were very satisfying in 46 of 47 (97.87%) patients and moderately satisfying in 1 (2.12%) patient. Overall, there were three (6.38%) complications.

Conclusion Our technique provides excellent functional and cosmetic outcomes. The overall surgical cost of these PMMA implants was lower than that of the other available cranioplasty implants. This technique is currently the most cost-effective option for cranioplasty.

Keywords

cranioplasty - 3D skull model - PMMA - low cost - novel technique - excellent - outcomes

Authors' Contributions

H.P.P. contributed to study conception and design, data collection, analysis and interpretation of results, and manuscript preparation. D.K.S. contributed to study conception and design, analysis and interpretation of results, and manuscript preparation.




Publication History

Received: 29 August 2023

Accepted: 17 January 2024

Article published online:
15 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Chibbaro S, Di Rocco F, Mirone G. et al. Decompressive craniectomy and early cranioplasty for the management of severe head injury: a prospective multicenter study on 147 patients. World Neurosurg 2011; 75 (3–4): 558-562
    CrossrefPubMedGoogle Scholar
  • 2 Kim BJ, Hong KS, Park KJ, Park DH, Chung YG, Kang SH. Customized cranioplasty implants using three-dimensional printers and polymethyl-methacrylate casting. J Korean Neurosurg Soc 2012; 52 (06) 541-546
    CrossrefPubMedGoogle Scholar
  • 3 Staffa G, Barbanera A, Faiola A. et al. Custom made bioceramic implants in complex and large cranial reconstruction: a two-year follow-up. J Craniomaxillofac Surg 2012; 40 (03) e65-e70
    CrossrefPubMedGoogle Scholar
  • 4 Morales-Gómez JA, Garcia-Estrada E, Leos-Bortoni JE. et al. Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer. J Neurosurg 2018; 130: 1-7
    PubMedGoogle Scholar
  • 5 Chamo D, Msallem B, Sharma N, Aghlmandi S, Kunz C, Thieringer FM. Accuracy assessment of molded, patient-specific polymethylmethacrylate craniofacial implants compared to their 3D printed originals. J Clin Med 2020; 9 (03) 832
    CrossrefPubMedGoogle Scholar
  • 6 Jayabalan M. Sterilization and reprocessing of materials and medical devices: reusability. J Biomater Appl 1995; 10 (01) 97-112
    CrossrefPubMedGoogle Scholar
  • 7 Eppley BL. Alloplastic cranioplasty. Oper Tech Plast Reconstr Surg 2002; 9: 16-22
    CrossrefPubMedGoogle Scholar
  • 8 Eppley BL. Biomechanical testing of alloplastic PMMA cranioplasty materials. J Craniofac Surg 2005; 16 (01) 140-143
    CrossrefPubMedGoogle Scholar
  • 9 Marchac D, Greensmith A. Long-term experience with methylmethacrylate cranioplasty in craniofacial surgery. J Plast Reconstr Aesthet Surg 2008; 61 (07) 744-752 , discussion 753
    CrossrefPubMedGoogle Scholar
  • 10 Honeybul S, Morrison DA, Ho KM, Lind CR, Geelhoed E. A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty. J Neurosurg 2017; 126 (01) 81-90
    CrossrefPubMedGoogle Scholar
  • 11 Sahuquillo J, Dennis JA. Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury. Cochrane Database Syst Rev 2019; 12 (12) CD003983
    PubMedGoogle Scholar
  • 12 Satapathy D, Nadeem M, Shukla DP, Prabhuraj AR, Devi BI. Cosmetic outcome of cranioplasty after decompressive craniectomy: an overlooked aspect. World Neurosurg 2019; 129: e81-e86
    CrossrefPubMedGoogle Scholar
  • 13 Shih F-Y, Lin C-C, Wang H-C. et al. Risk factors for seizures after cranioplasty. Seizure 2019; 66: 15-21
    CrossrefPubMedGoogle Scholar
  • 14 Binhammer A, Jakubowski J, Antonyshyn O, Binhammer P. Comparative cost-effectiveness of cranioplasty implants. Plast Surg (Oakv) 2020; 28 (01) 29-39
    CrossrefPubMedGoogle Scholar
  • 15 Matsuno A, Tanaka H, Iwamuro H. et al. Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochir (Wien) 2006; 148 (05) 535-540 , discussion 540
    CrossrefPubMedGoogle Scholar
  • 16 De La Peña A, De La Peña-Brambila J, Pérez-De La Torre J, Ochoa M, Gallardo GJ. Low-cost customized cranioplasty using a 3D digital printing model: a case report. 3D Print Med 2018; 4 (01) 4
    CrossrefPubMedGoogle Scholar
  • 17 Lee S-C, Wu C-T, Lee S-T, Chen P-J. Cranioplasty using polymethyl methacrylate prostheses. J Clin Neurosci 2009; 16 (01) 56-63
    CrossrefPubMedGoogle Scholar
  • 18 Cheng C-H, Chuang H-Y, Lin H-L, Liu C-L, Yao C-H. Surgical results of cranioplasty using three-dimensional printing technology. Clin Neurol Neurosurg 2018; 168: 118-123
    CrossrefPubMedGoogle Scholar
  • 19 Morales-Gómez JA, Garcia-Estrada E, Leos-Bortoni JE. et al. Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer. J Neurosurg 2018; 12: 1-7
    PubMedGoogle Scholar
  • 20 Schön SN, Skalicky N, Sharma N, Zumofen DW, Thieringer FM. 3D-printer-assisted patient-specific polymethyl methacrylate cranioplasty: a case series of 16 consecutive patients. World Neurosurg 2021; 148: e356-e362
    CrossrefPubMedGoogle Scholar
  • 21 Moreira-Gonzalez A, Jackson IT, Miyawaki T, Barakat K, DiNick V. Clinical outcome in cranioplasty: critical review in long-term follow-up. J Craniofac Surg 2003; 14 (02) 144-153
    CrossrefPubMedGoogle Scholar
  • 22 Unterhofer C, Wipplinger C, Verius M, Recheis W, Thomé C, Ortler M. Reconstruction of large cranial defects with poly-methyl-methacrylate (PMMA) using a rapid prototyping model and a new technique for intraoperative implant modeling. Neurol Neurochir Pol 2017; 51 (03) 214-220
    CrossrefPubMedGoogle Scholar
  • 23 Apriawan T, Permana KR, Darlan D. et al. Polylactic acid implant for cranioplasty with 3-dimensional printing customization: a case report. Open Access Maced J Med Sci 2020; 8: 151-155
    CrossrefPubMedGoogle Scholar
  • 24 Freeland B, McCarthy E, Balakrishnan R. et al. A review of polylactic acid as a replacement material for single-use laboratory components. Materials (Basel) 2022; 15 (09) 2989
    CrossrefPubMedGoogle Scholar
  • 25 Czyżewski W, Jachimczyk J, Hoffman Z. et al. Low-cost cranioplasty: a systematic review of 3D printing in medicine. Materials (Basel) 2022; 15 (14) 4731
    CrossrefPubMedGoogle Scholar
  • 26 Lethaus B, Bloebaum M, Koper D, Poort-Ter Laak M, Kessler P. Interval cranioplasty with patient-specific implants and autogenous bone grafts: success and cost analysis. J Craniomaxillofac Surg 2014; 42 (08) 1948-1951
    CrossrefPubMedGoogle Scholar
  • 27 Fischer CM, Burkhardt JK, Sarnthein J, Bernays RL, Bozinov O. Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty: a questionnaire-based single-centre study. Neurol Res 2012; 34 (03) 281-285
    CrossrefPubMedGoogle Scholar