Artikel
Cost-effective intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty
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Veröffentlicht: | 28. April 2011 |
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Gliederung
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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.