title: Computer-based surgical planning and custom-made titanium implants for cranial fibrous dysplasia.
abstract: BACKGROUND
  The procedure of reconstruction after the removal of cranial fibrous dysplasia (FD) must be precise to achieve good functional and aesthetic results. Intraoperative modeling of implants is difficult and may cause cosmetic disturbances.
  
  
  OBJECTIVE
  To present our experience with the treatment of cranial FD using preoperative computer-based surgical planning of tumor removal with reconstruction of the cranium with custom-made titanium implants.
  
  
  METHODS
  Four patients underwent surgical treatment for cranial FD over a 2-year period. All patients were male with a mean age of 25.25 years and had monostotic-type FD. Computed tomography (CT) with 0.5-mm slices was obtained preoperatively. Computer-based planning of the tumor removal was performed, and a template was created by the computer to determine the margins of tumor removal. After this procedure, the preoperative computer-based construction of the titanium implant was performed. The patients underwent surgical treatment, and the tumor was removed with the use of this template. Then, the titanium implant was inserted onto the bone defect and fixed with mini-screws. Patients were followed up by periodic CT scans.
  
  
  RESULTS
  The histological diagnosis of all patients was FD. No intraoperative or postoperative complications have occurred. Postoperative CT scans showed complete tumor removal and confirmed appropriate cosmetic reconstruction. The mean follow-up period was 15.25 months.
  
  
  CONCLUSIONS
  Computer-based surgical planning associated with the production of custom-made titanium implants is a highly promising method for the treatment of cranial FD. Better radiological and cosmetic outcomes could be obtained by this technique with interdisciplinary work with medical designers.
authors.affiliation: *Department of Neurosurgery and ‡Medical Design and Production Center, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Ozkan
authors.initials: O
authors.lastname: Tehli
authors.forename: Ahmet Murat
authors.initials: AM
authors.lastname: Dursun
authors.forename: Caglar
authors.initials: C
authors.lastname: Temiz
authors.forename: Ilker
authors.initials: I
authors.lastname: Solmaz
authors.forename: Cahit
authors.initials: C
authors.lastname: Kural
authors.forename: Murat
authors.initials: M
authors.lastname: Kutlay
authors.forename: Yunus
authors.initials: Y
authors.lastname: Kacar
authors.forename: Mehmet Can
authors.initials: MC
authors.lastname: Ezgu
authors.forename: Erbil
authors.initials: E
authors.lastname: Oguz
authors.forename: Mehmet K
authors.initials: MK
authors.lastname: Daneyemez
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Izci
mesh_terms: D000328:Adult; D005357:Fibrous Dysplasia of Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012886:Skull / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014025:Titanium; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D014025:Titanium