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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 Preformed PMMA implants made by hand have been superseded by newer 3-D printed implants, but this is accompanied by higher costs and timing issues, apart from having limited availability in developing and third-world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

Postoperative result. (a) Right oblique view; (b) Right lateral view
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Figure 3: Postoperative result. (a) Right oblique view; (b) Right lateral view

Mentions: Patient satisfaction was assessed on follow-up visits. Out of the 26 patients, 24 (92.4%) felt comfortable with their aesthetic result, and did not inquire about a second operation for cosmetic improvement [Figure 3]. Only the two patients who suffered from temporal muscle atrophy requested an additional surgical intervention for cosmetic improvement, which involved filling of the defect with silicone.


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)

Postoperative result. (a) Right oblique view; (b) Right lateral view
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Postoperative result. (a) Right oblique view; (b) Right lateral view
Mentions: Patient satisfaction was assessed on follow-up visits. Out of the 26 patients, 24 (92.4%) felt comfortable with their aesthetic result, and did not inquire about a second operation for cosmetic improvement [Figure 3]. Only the two patients who suffered from temporal muscle atrophy requested an additional surgical intervention for cosmetic improvement, which involved filling of the defect with silicone.

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