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1643. Additive Manufacturing of 3D Printed Customized Implant for Cranial Bone Defect Repair. A 3-case Report

Authors: Bruno Splavski, MD; Marko Kovacevic, MD; Goran Lakicevic, MD; Zdrinko Brekalo, MD; Kresimir Rotim, MD; Brano Splavski Jr., MD (Osijek, Croatia)

Introduction: Additive manufacturing of 3D printed prefabricated cranioplastic implant has been recently initiated as a method for the repair of a skull bone defect due to traumatic brain injury and/or decompressive craniotomy. To support surgical and cosmetic outcome, the ideal implant is supposed to be well-built and strong enough, as well as appropriate for the entire bone defect closing. The aim of this article is to appraise 3D additive manufacturing as a procedure preceding contemporary personalized cranioplasty. It is based on our reconstructive surgery experience gained while dealing with skull bone defects of 3 consecutive cases.

Methods: A bone defect cranioplasty was performed in 3 patients having unilateral large (>100 cm2) craniectomy. Personalized data imaging from preoperative computed tomography (CT) of the head in Digital Imaging and Communications in Medicine (DICOM) format were calculated and converted into Surface Tessellation Language (STL) format preparing them for 3D printing. A digital subtraction mirror-imaging method was employed to produce the implant’s image model. A polymethyl-methacrylate (PMMA) implant was designed using the 3D customized sterilized mold and built-in into the bone defect at some stage in surgery.

Results: Cosmetically appropriate, excellent cranial defect restoration was achieved in all patients following reconstructive surgery. No postoperative complications related to the procedure were observed during a follow-up.

Conclusion: Additive manufacturing of 3D printed customized implants for a skull defect repair is a precious and modern reconstructive surgery technique. It is particularly valuable for the restoration of large bone defects with multifaceted geometry having a thriving cosmetic effect.