Limits...
Cranioplasty with polymethylmethacrylate prostheses fabricated by hand using original bone flaps: Technical note and surgical outcomes.

Caro-Osorio E, De la Garza-Ramos R, Martínez-Sánchez SR, Olazarán-Salinas F - Surg Neurol Int (2013)

Bottom Line: The result was an exact duplication of the patient's bone flap.Only two patients (7.6%) suffered from direct cranioplasty-related complications after a median follow-up of 10.4 months.Prefabrication of custom PMMA prostheses by hand when original bone flaps are available is an excellent alternative to newer 3-D printing techniques, because it is relatively cheaper, less time consuming, and offers excellent results in terms of anatomical reconstruction and improvement of neurological function in long-term follow-ups.

View Article: PubMed Central - PubMed

Affiliation: Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion, Tec Salud, Monterrey, Nuevo León, México.

ABSTRACT

Background: Decompressive craniectomies (DC) mandate future cranioplasties, accounting for the large array of biomaterials for this purpose. Polymethylmethacrylate (PMMA) is a very reliable thermoplastic that can be prefabricated or even molded intraoperatively to create an adequate prosthesis. Preformed PMMA implants made by hand have been superseded by newer 3-D printed implants, but this is accompanied by higher costs and timing issues, apart from having limited availability in developing and third-world countries.

Methods: A total of 26 patients were operated over a span of 11 years. A total of 26 custom hand-made PMMA prostheses were fabricated using original bone flaps with the aid of a prosthodontist, in a process that took approximately 70 minutes for each implant. The result was an exact duplication of the patient's bone flap.

Results: Of the 26 patients who underwent cranioplasty, the majority of patients were males, with a mean age of 39.2 years and traumatic brain injury as main indication for DC. After a mean interval of 2.4 months, all 26 patients underwent a cranioplasty and prosthesis placement. Only two patients (7.6%) suffered from direct cranioplasty-related complications after a median follow-up of 10.4 months. Median Glasgow Outcome Scale scores improved significantly from 3 to 4 after cranioplasty (P = 0.008).

Conclusion: Prefabrication of custom PMMA prostheses by hand when original bone flaps are available is an excellent alternative to newer 3-D printing techniques, because it is relatively cheaper, less time consuming, and offers excellent results in terms of anatomical reconstruction and improvement of neurological function in long-term follow-ups.

No MeSH data available.


Related in: MedlinePlus

Key steps in the PMMA prosthesis fabrication
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3815033&req=5

Figure 1: Key steps in the PMMA prosthesis fabrication

Mentions: The bone flap was inspected and the burr holes filled with methylmethacrylate (MMA; Codman Cranioplastic, Type 1-Slow Set, Johnson and Johnson, Raynham, MA) in a power-to-liquid ratio of 2:1. Thin areas of the bony flap were augmented with MMA to increase thickness to 2-3 mm. The C-Silicone (Speedex Putty, Coltène/Whaledent, Altstatten, Switzerland) was put over the working table in a sufficient amount to cover the internal surface of the bony flap, and was then mixed with the Universal Activator (Speedex Universal Activator, Coltène/Whaledent, Altstatten, Switzerland) for 2 minutes. The internal surface of the bony flap was covered with petroleum jelly body lotion and placed over the mixture and an impression was made in 5 minutes (the C-Silicone should not surpass the lateral borders of the bony flap). The same process was repeated for the external surface of the bony flap [Figure 1a]. Once both surfaces were impressed, the mold was opened and covered with petroleum jelly over both surfaces [Figure 1b]. The internal aspect of the mold was slowly filled with MMA, avoiding spillage as much as possible [Figure 1c]. Once a fair amount of internal surface was covered, the external mold was placed over the MMA for several seconds to give shape to the external surface. This process took about 40 minutes. Finally, the PMMA prosthesis was removed from the C-Silicone mold and excess protrusions at the margins were trimmed with a rongeur. The result is an exact duplication of the patient's bone flap [Figure 1d].


Cranioplasty with polymethylmethacrylate prostheses fabricated by hand using original bone flaps: Technical note and surgical outcomes.

Caro-Osorio E, De la Garza-Ramos R, Martínez-Sánchez SR, Olazarán-Salinas F - Surg Neurol Int (2013)

Key steps in the PMMA prosthesis fabrication
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815033&req=5

Figure 1: Key steps in the PMMA prosthesis fabrication
Mentions: The bone flap was inspected and the burr holes filled with methylmethacrylate (MMA; Codman Cranioplastic, Type 1-Slow Set, Johnson and Johnson, Raynham, MA) in a power-to-liquid ratio of 2:1. Thin areas of the bony flap were augmented with MMA to increase thickness to 2-3 mm. The C-Silicone (Speedex Putty, Coltène/Whaledent, Altstatten, Switzerland) was put over the working table in a sufficient amount to cover the internal surface of the bony flap, and was then mixed with the Universal Activator (Speedex Universal Activator, Coltène/Whaledent, Altstatten, Switzerland) for 2 minutes. The internal surface of the bony flap was covered with petroleum jelly body lotion and placed over the mixture and an impression was made in 5 minutes (the C-Silicone should not surpass the lateral borders of the bony flap). The same process was repeated for the external surface of the bony flap [Figure 1a]. Once both surfaces were impressed, the mold was opened and covered with petroleum jelly over both surfaces [Figure 1b]. The internal aspect of the mold was slowly filled with MMA, avoiding spillage as much as possible [Figure 1c]. Once a fair amount of internal surface was covered, the external mold was placed over the MMA for several seconds to give shape to the external surface. This process took about 40 minutes. Finally, the PMMA prosthesis was removed from the C-Silicone mold and excess protrusions at the margins were trimmed with a rongeur. The result is an exact duplication of the patient's bone flap [Figure 1d].

Bottom Line: The result was an exact duplication of the patient's bone flap.Only two patients (7.6%) suffered from direct cranioplasty-related complications after a median follow-up of 10.4 months.Prefabrication of custom PMMA prostheses by hand when original bone flaps are available is an excellent alternative to newer 3-D printing techniques, because it is relatively cheaper, less time consuming, and offers excellent results in terms of anatomical reconstruction and improvement of neurological function in long-term follow-ups.

View Article: PubMed Central - PubMed

Affiliation: Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion, Tec Salud, Monterrey, Nuevo León, México.

ABSTRACT

Background: Decompressive craniectomies (DC) mandate future cranioplasties, accounting for the large array of biomaterials for this purpose. Polymethylmethacrylate (PMMA) is a very reliable thermoplastic that can be prefabricated or even molded intraoperatively to create an adequate prosthesis. Preformed PMMA implants made by hand have been superseded by newer 3-D printed implants, but this is accompanied by higher costs and timing issues, apart from having limited availability in developing and third-world countries.

Methods: A total of 26 patients were operated over a span of 11 years. A total of 26 custom hand-made PMMA prostheses were fabricated using original bone flaps with the aid of a prosthodontist, in a process that took approximately 70 minutes for each implant. The result was an exact duplication of the patient's bone flap.

Results: Of the 26 patients who underwent cranioplasty, the majority of patients were males, with a mean age of 39.2 years and traumatic brain injury as main indication for DC. After a mean interval of 2.4 months, all 26 patients underwent a cranioplasty and prosthesis placement. Only two patients (7.6%) suffered from direct cranioplasty-related complications after a median follow-up of 10.4 months. Median Glasgow Outcome Scale scores improved significantly from 3 to 4 after cranioplasty (P = 0.008).

Conclusion: Prefabrication of custom PMMA prostheses by hand when original bone flaps are available is an excellent alternative to newer 3-D printing techniques, because it is relatively cheaper, less time consuming, and offers excellent results in terms of anatomical reconstruction and improvement of neurological function in long-term follow-ups.

No MeSH data available.


Related in: MedlinePlus