PMID- 28343651 OWN - NLM STAT- MEDLINE DCOM- 20170817 LR - 20221207 IS - 0028-3843 (Print) IS - 0028-3843 (Linking) VI - 51 IP - 3 DP - 2017 May-Jun TI - Reconstruction of large cranial defects with poly-methyl-methacrylate (PMMA) using a rapid prototyping model and a new technique for intraoperative implant modeling. PG - 214-220 LID - S0028-3843(16)30226-2 [pii] LID - 10.1016/j.pjnns.2017.02.007 [doi] AB - BACKGROUND: Reconstruction of large cranial defects after craniectomy can be accomplished by free-hand poly-methyl-methacrylate (PMMA) or industrially manufactured implants. The free-hand technique often does not achieve satisfactory cosmetic results but is inexpensive. In an attempt to combine the accuracy of specifically manufactured implants with low cost of PMMA. METHODS: Forty-six consecutive patients with large skull defects after trauma or infection were retrospectively analyzed. The defects were reconstructed using computer-aided design/computer-aided manufacturing (CAD/CAM) techniques. The computer file was imported into a rapid prototyping (RP) machine to produce an acrylonitrile-butadiene-styrene model (ABS) of the patient's bony head. The gas-sterilized model was used as a template for the intraoperative modeling of the PMMA cranioplasty. Thus, not the PMMA implant was generated by CAD/CAM technique but the model of the patients head to easily form a well-fitting implant. Cosmetic outcome was rated on a six-tiered scale by the patients after a minimum follow-up of three months. RESULTS: The mean size of the defect was 74.36cm(2). The implants fitted well in all patients. Seven patients had a postoperative complication and underwent reoperation. Mean follow-up period was 41 months (range 2-91 months). Results were excellent in 42, good in three and not satisfactory in one patient. Costs per implant were approximately 550 Euros. CONCLUSION: PMMA implants fabricated in-house by direct molding using a bio-model of the patients bony head are easily produced, fit properly and are inexpensive compared to cranial implants fabricated with other RP or milling techniques. CI - Copyright (c) 2017 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved. FAU - Unterhofer, Claudia AU - Unterhofer C AD - Clinical Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria. Electronic address: claudia.unterhofer@uki.at. FAU - Wipplinger, Christoph AU - Wipplinger C AD - Clinical Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria. Electronic address: christoph.wipplinger@tirol-kliniken.at. FAU - Verius, Michael AU - Verius M AD - Clinical Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. Electronic address: michael.verius@tirol-kliniken.at. FAU - Recheis, Wolfgang AU - Recheis W AD - Clinical Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. Electronic address: wolfgang.recheis@tirol-kliniken.at. FAU - Thome, Claudius AU - Thome C AD - Clinical Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria. Electronic address: claudius.thome@tirol-kliniken.at. FAU - Ortler, Martin AU - Ortler M AD - Clinical Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria. Electronic address: martin.ortler@tirol-kliniken.at. LA - eng PT - Journal Article DEP - 20170310 PL - Poland TA - Neurol Neurochir Pol JT - Neurologia i neurochirurgia polska JID - 0101265 RN - 9011-14-7 (Polymethyl Methacrylate) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Child MH - *Computer-Aided Design MH - Craniotomy/*methods MH - Female MH - Follow-Up Studies MH - Humans MH - Intraoperative Period MH - Male MH - Middle Aged MH - Models, Anatomic MH - *Polymethyl Methacrylate MH - Postoperative Complications/etiology/surgery MH - *Prostheses and Implants MH - Prosthesis Design MH - Plastic Surgery Procedures/*methods MH - Reoperation MH - Young Adult OTO - NOTNLM OT - Cranioplasty OT - Poly-methyl-methacrylate (PMMA) OT - Rapid prototyping OT - Stereolithography EDAT- 2017/03/28 06:00 MHDA- 2017/08/18 06:00 CRDT- 2017/03/28 06:00 PHST- 2016/11/26 00:00 [received] PHST- 2017/02/06 00:00 [revised] PHST- 2017/02/23 00:00 [accepted] PHST- 2017/03/28 06:00 [pubmed] PHST- 2017/08/18 06:00 [medline] PHST- 2017/03/28 06:00 [entrez] AID - S0028-3843(16)30226-2 [pii] AID - 10.1016/j.pjnns.2017.02.007 [doi] PST - ppublish SO - Neurol Neurochir Pol. 2017 May-Jun;51(3):214-220. doi: 10.1016/j.pjnns.2017.02.007. Epub 2017 Mar 10.