title: Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty.
abstract: Cranioplasty is a common neurosurgical procedure. Free-hand molding of polymethyl methacrylate (PMMA) cement into complex three-dimensional shapes is often time-consuming and may result in disappointing cosmetic outcomes. Computer-assisted patient-specific implants address these disadvantages but are associated with long production times and high costs. In this study, we evaluated the clinical, radiological, and cosmetic outcomes of a time-saving and inexpensive intraoperative method to mold custom-made implants for immediate single-stage or delayed cranioplasty. Data were collected from patients in whom cranioplasty became necessary after removal of bone flaps affected by intracranial infection, tumor invasion, or trauma. A PMMA replica was cast between a negative form of the patient's own bone flap and the original bone flap with exactly the same shape, thickness, and dimensions. Clinical and radiological follow-up was performed 2 months post-surgery. Patient satisfaction (Odom criteria) and cosmesis (visual analogue scale for cosmesis) were evaluated 1 to 3 years after cranioplasty. Twenty-seven patients underwent intraoperative template-molded patient-specific cranioplasty with PMMA. The indications for cranioplasty included bone flap infection (56%, n = 15), calvarian tumor resection (37%, n = 10), and defect after trauma (7%, n = 2). The mean duration of the molding procedure was 19 ± 7 min. Excellent radiological implant alignment was achieved in 94% of the cases. All (n = 23) but one patient rated the cosmetic outcome (mean 1.4 years after cranioplasty) as excellent (70%, n = 16) or good (26%, n = 6). Intraoperative cast-molded reconstructive cranioplasty is a feasible, accurate, fast, and cost-efficient technique that results in excellent cosmetic outcomes, even with large and complex skull defects.
authors.affiliation: Department of Neurosurgery, University Hospital Bern, Bern, Switzerland. serge.marbacher@ksa.ch
authors.forename: Serge
authors.initials: S
authors.lastname: Marbacher
authors.forename: Lukas
authors.initials: L
authors.lastname: Andereggen
authors.forename: Salome
authors.initials: S
authors.lastname: Erhardt
authors.forename: Ali-Reza
authors.initials: AR
authors.lastname: Fathi
authors.forename: Javier
authors.initials: J
authors.lastname: Fandino
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001843:Bone Cements; D001860:Bone Plates; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019904:Polymethyl Methacrylate; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000293:injuries; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000601:surgery; D014025:Titanium; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate; D014025:Titanium