gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Cost-effective intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty

Meeting Abstract

  • S. Marbacher - Department of Neurosurgery, University Hospital Bern, Bern, Switzerland; Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
  • L. Andereggen - Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
  • S. Erhardt - Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
  • A.R. Fathi - Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
  • J. Fandino - Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
  • A. Raabe - Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
  • J. Beck - Department of Neurosurgery, University Hospital Bern, Bern, Switzerland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 034

DOI: 10.3205/11dgnc255, URN: urn:nbn:de:0183-11dgnc2557

Published: April 28, 2011

© 2011 Marbacher et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Cranioplasty is a frequent neurosurgical procedure. Freehand molding of polymethyl methacrylate (PMMA) cement into complex three-dimensional shapes remains, however, 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. The authors present their data with a time-saving and inexpensive intraoperative method to mold custom-made implants for either immediate single-stage or delayed cranioplasty.

Methods: Patients in whom cranioplasty became necessary after removal of bone flaps affected by intracranial infection, tumor invasion, or trauma were selected. 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 two months post-surgery. Patient satisfaction (Odom criteria) and cosmesis (visual analog scale for cosmesis) were evaluated one to three years after cranioplasty.

Results: 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 minutes. Excellent radiological implant alignment was achieved in 94% of 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).

Conclusions: Even with large and complex skull defects, intraoperative cast-molded reconstructive cranioplasty is an accurate, fast, and cost-efficient method that results in excellent cosmetic outcomes.