Evaluation of implant properties,safety profile and clinical efficacy of patient-specific acrylic prosthesis in cranioplasty using 3D binderjet printed cranium model: A pilot study |
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| Affiliation: | 1. Materials Research Center, Indian Institute of Science, Bangalore 560012, India;2. Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India;3. Department of Metallurgical and Materials Engineering, National Institute of Technology, Surathkal, Mangaluru 575025, Karnataka, India;4. Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka 560054, India;5. Department of Dental Sciences , Ramaiah Memorial Hospital Bengaluru, Karnataka 560054, India;1. Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia;2. Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA;1. Neurorestoration Centre, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, 1333 San Pablo Street, Room B51 McKibben Hall, Los Angeles, CA 90033, USA;2. Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA;1. School of Medicine, Vanderbilt University, Nashville, TN, United States;2. Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI, United States;3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States;4. Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States;5. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, United States;1. Department of Neurosurgery, University of California San Francisco, United States;2. Department of Orthopedic Surgery, University of California San Francisco, United States;1. Department of Neurosurgery, Qingdao Municipal Hospital, 266071 Qingdao, China;2. Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 100070 Beijing, China;1. Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;2. Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands |
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| Abstract: | There exists a significant demand to develop patient-specific prosthesis in reconstruction of cranial vaults after decompressive craniectomy. we report here, the outcomes of an unicentric pilot study on acrylic cranial prosthesis fabricated using a 3D printed cranium model with its clinically relevant mechanical properties.MethodsThe semi-crystalline polymethyl methacrylate (PMMA) implants, shaped to the cranial defects of 3D printed cranium model, were implanted in 10 patients (mean age, 40.8 ± 14.8 years). A binderjet 3D printer was used to create patient-specific mould and PMMA was casted to fabricate prosthesis which was analyzed for microstructure and properties. Patients were followed up for allergy, infection and cosmesis for a period of 6 months.ResultsAs-cast PMMA flap exhibited hardness of 15.8 ± 0.24Hv, tensile strength of 30.7 ± 3.9 MPa and elastic modulus of 1.5 ± 0.1 GPa. 3D microstructure of the semi-crystalline acrylic implant revealed 2.5–15 µm spherical isolated pores. The mean area of the calvarial defect in craniectomy patients was 94.7 ± 17.4 cm2. We achieved a cranial index of symmetry (CIS -%) of 94.5 ± 3.9, while the average post-operative Glasgow outcome scale (GOS) score recorded was 4.2 ± 0.9.Conclusions3D printing based patient-specific design and fabrication of acrylic cranioplasty implant is safe and achieves acceptable cosmetic and clinical outcomes in patients with decompressive craniectomy. Our study ensured clinically acceptable structural and mechanical properties of implanted PMMA, suggesting that a low cost 3D printer based PMMA flap is an affordable option for cranioplasty in resource constrained settings. |
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| Keywords: | Decompressive craniectomy Cranium model 3D printing Polymethyl methacrylate Cranioplasty |
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