gms | German Medical Science

Objective: Conventionally offered computer-aided design(CAD) cranioplasty implants are merely shaped with respect to the bony defect. Temporal muscle atrophy and displacement following decompressive craniectomy and time delayed cranioplasty are not taken into account, resulting in a typical residual mass and contour defect at the temple. This can present a considerable esthetic discomfort for patients and their surroundings. The aim of this analysis is to improve the optic result of cranioplasty by anticipation of the contour defect at the time of the CAD session.

Methods: We analyzed CT data of 10 patients who had undergone both craniectomy and conventional CAD cranioplasty in our institution. The skin contour of the temple after these two procedures was subtracted from the initial contour prior to decompression with a dedicated software(Amira, Thermo Fisher Scientific). The so derived volumetric soft tissue defect was substituted at the cranioplastic prosthesis itself, including shaping of an attachment area at the new lip position of the shortened atrophic temporal muscle. The precise localization for this added material onto the prosthesis was verified by 3D printing of the craniectomized skull, the modified prosthesis and by molding of a flexible silicone layer simulating the consecutive skin contour.

Results: The average volumetric temple loss to be addedas respective volume to the prosthesis was 3.9 ml ± 1.2 ml.This led to a cosmetically improved result of the temple contour in the combined printed and silicone models. The presentation will include detailed CAD image and photo material.

Conclusion: The result of a combined, one piece bone-soft tissue-prosthesis in this pilot study suggests improved esthetic outcome and patient satisfaction following cranioplasty involving the region of the temple. The anticipation of the defect to expect and compensation with an already approved implant material in one piece facilitates the steps towards surgical use.