Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Customized Cranioplasty Implants Using Three-Dimensional Printers and Polymethyl-Methacrylate Casting

  • Kim, Bum-Joon (Department of Neurosurgery, Korea University College of Medicine) ;
  • Hong, Ki-Sun (Department of Neurosurgery, Korea University College of Medicine) ;
  • Park, Kyung-Jae (Department of Neurosurgery, Korea University College of Medicine) ;
  • Park, Dong-Hyuk (Department of Neurosurgery, Korea University College of Medicine) ;
  • Chung, Yong-Gu (Department of Neurosurgery, Korea University College of Medicine) ;
  • Kang, Shin-Hyuk (Department of Neurosurgery, Korea University College of Medicine)
  • Received : 2012.06.18
  • Accepted : 2012.12.18
  • Published : 2012.12.28
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Abstract

Objective : The prefabrication of customized cranioplastic implants has been introduced to overcome the difficulties of intra-operative implant molding. The authors present a new technique, which consists of the prefabrication of implant molds using three-dimensional (3D) printers and polymethyl-methacrylate (PMMA) casting. Methods : A total of 16 patients with large skull defects (>100 $cm^2$) underwent cranioplasty between November 2009 and April 2011. For unilateral cranial defects, 3D images of the skull were obtained from preoperative axial 1-mm spiral computed tomography (CT) scans. The image of the implant was generated by a digital subtraction mirror-imaging process using the normal side of the cranium as a model. For bilateral cranial defects, precraniectomy routine spiral CT scan data were merged with postcraniectomy 3D CT images following a smoothing process. Prefabrication of the mold was performed by the 3D printer. Intraoperatively, the PMMA implant was created with the prefabricated mold, and fit into the cranial defect. Results : The median operation time was $184.36{\pm}26.07$ minutes. Postoperative CT scans showed excellent restoration of the symmetrical contours and curvature of the cranium in all cases. The median follow-up period was 23 months (range, 14-28 months). Postoperative infection was developed in one case (6.2%) who had an open wound defect previously. Conclusion : Customized cranioplasty PMMA implants using 3D printer may be a useful technique for the reconstruction of various cranial defects.

Keywords

References

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