Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty

Marbacher, Serge; Andereggen, Lukas; Erhardt, Salome; Fathi, Ali-Reza; Fandino, Javier; Raabe, Andreas; Beck, Jürgen (2012). Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty. Neurosurgical review, 35(4), 527-35; discussion 535. Berlin: Springer-Verlag 10.1007/s10143-012-0376-3

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

?? DCD5A442BAF9E17DE0405C82790C4DE2 ??
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Marbacher, Serge; Andereggen, Lukas; Raabe, Andreas and Beck, Jürgen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0344-5607

Publisher:

Springer-Verlag

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:37

Last Modified:

26 Jun 2018 14:54

Publisher DOI:

10.1007/s10143-012-0376-3

PubMed ID:

22391771

Web of Science ID:

000308825500013

BORIS DOI:

10.7892/boris.14827

URI:

https://boris.unibe.ch/id/eprint/14827 (FactScience: 221958)

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