Using Computer-Aided Design/Computer-Aided Manufacturing for Autogenous, Split Calvarial Bone Graft-based...

Area of Science:

• Neurosurgery
• Plastic Surgery
• Biomedical Engineering

Background:

• Autologous split calvarial bone is ideal for cranioplasty but donor site selection is challenging for complex defects.
• Computer-aided design and manufacturing (CAD/CAM) may optimize harvest and contouring, reducing complications.
• CAD/CAM has not been previously studied for split calvarial bone graft cranioplasty in complex cases.

Observation:

• A retrospective review of five patients with full-thickness cranial defects (≥30 cm²) undergoing CAD/CAM-assisted split-calvarial bone graft cranioplasty was performed.
• Data collected included patient demographics, prior complications, operative variables, and short-term/long-term outcomes.
• CAD/CAM predicted graft measurements were compared to actual postoperative measurements.

Findings:

• The mean defect size was 69 cm², with a mean operative time of 443 minutes and blood loss of 450 mL.
• No intraoperative complications (e.g., dural tears, sinus bleeds) or immediate postoperative complications requiring extended stay or reoperation occurred.
• Postoperative graft surface area was within 2.1% of the planned area (P=0.28), and all patients reported satisfaction with cranial contour.

Implications:

• CAD/CAM enhances calvarial graft selection and contour accuracy in complex skull defect reconstruction.
• This technology offers a promising solution for challenging cranioplasty cases, leading to improved aesthetic and functional outcomes.
• Early experience suggests CAD/CAM facilitates safer and more precise cranioplasty procedures with minimal complications.