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Outcomes and Workflow in a Titanium Powder Bed Fusion Cranial Reparation Surgery Service.

Tommi K Korhonen1, Ivan Timofeev1, Harry Mee2

  • 1Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, United Kingdom.

3D Printing and Additive Manufacturing
|December 4, 2025
PubMed
Summary
This summary is machine-generated.

Cranioplasty implants made with titanium powder bed fusion show complication and removal rates comparable to existing methods. Patients with cerebrospinal fluid shunts or poor health face higher risks of infection and implant failure.

Keywords:
alloplastcranioplastyinfectionpowder bed fusiontitanium

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Area of Science:

  • Neurosurgery and Biomedical Engineering
  • Materials Science in Medical Implants

Background:

  • Cranioplasty reconstructs skull defects after craniectomy, but complications necessitate implant removal in 10-20% of cases.
  • The optimal material for cranioplasty implants remains undetermined, leading to variable patient outcomes.

Purpose of the Study:

  • To assess the safety and efficacy of a multidisciplinary cranial repair service utilizing grade 23 Ti-6Al-4V powder bed fusion (PBF) cranioplasty implants.
  • To compare complication and implant removal rates of PBF titanium cranioplasties with existing technologies.

Main Methods:

  • Retrospective analysis of 107 cranioplasty procedures in 105 patients using PBF-manufactured grade 23 Ti-6Al-4V implants.
  • Data collected from December 2017 to December 2021 at Cambridge University Hospital.
  • Primary outcome: implant removal; Secondary outcome: cranioplasty infections.

Main Results:

  • Overall complication rate was 22% (24/107 patients), with 10% (11/107) requiring implant removal.
  • Surgical site infections occurred in 12% (13/107) of patients, leading to implant removal in 7% (8/107).
  • Cerebrospinal fluid shunt placement (HR 8.57) and high ASA grade (HR 6.87) predicted shorter implant survival.

Conclusions:

  • PBF-manufactured titanium cranioplasties demonstrate complication and removal rates comparable to literature benchmarks.
  • The established multidisciplinary service allows for tailored surgery and future innovation in cranioplasty.
  • Patients with cerebrospinal fluid shunts and poor general health are at increased risk of infection and cranioplasty failure.