Template Routed Patient-Specific Implant for 1-Stage Cranioplasty

Area of Science:

• Neurosurgery
• Medical Device Engineering
• 3D Printing in Medicine

Background:

• Cranial reconstruction is challenging, especially with skull invasion.
• Traditional methods like titanium mesh and bone cement have limitations.
• Patient-specific implants (PSIs) require precise craniotomy for optimal results.

Purpose of the Study:

• To present a meticulous method for high-fidelity craniotomy and single-stage cranioplasty using PSIs.
• To improve the precision and efficiency of cranial reconstruction procedures.

Main Methods:

• Preoperative planning using computer-assisted design and 3D printing based on CT scans.
• Intraoperative fabrication of polymethyl methacrylate (PMMA) replicas using molds.
• Neuronavigation-assisted template positioning and fixation with mini-screws.
• Template-guided bone resection using a craniotomy router.
• Implant fixation with plates and screws.

Main Results:

• Successful implementation in 2 cases of meningiomas with osseous invasion.
• Demonstrated a cost-effective, streamlined, and precise single-stage craniotomy-cranioplasty procedure.
• High levels of patient satisfaction reported.

Conclusions:

• The template-guided PSI technique refines previous methods for accurate craniotomy matching.
• Achieves aesthetic outcomes comparable to hand-shaped methods and 2-stage PSI cranioplasties.
• Further studies are needed to validate the findings.