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Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty

Marbacher, Serge ; Andereggen, Lukas ; Erhardt, Salome ; Fathi, Ali-Reza ; Fandino, Javier ; Raabe, Andreas ; Beck, Jürgen

In: Neurosurgical Review, 2012, vol. 35, no. 4, p. 527-535

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    Titre
    • Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty
    Auteur
    • Marbacher, Serge. Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
    • Andereggen, Lukas. Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
    • Erhardt, Salome. Department of Neurosurgery, Kantonsspital Aarau, 3010, Aarau, Switzerland
    • Fathi, Ali-Reza. Department of Neurosurgery, Kantonsspital Aarau, 3010, Aarau, Switzerland
    • Fandino, Javier. Department of Neurosurgery, Kantonsspital Aarau, 3010, Aarau, Switzerland
    • Raabe, Andreas. Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
    • Beck, Jürgen. Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:317895
    Summary
    Cranioplasty is a common neurosurgical procedure. Free-hand molding of polymethyl methacrylate (PMMA) cement into complex three-dimensional shapes is often time-consuming and may result in disappointing cosmetic outcomes. Computer-assisted patient-specific implants address these disadvantages but are associated with long production times and high costs. In this study, we evaluated the clinical, radiological, and cosmetic outcomes of a time-saving and inexpensive intraoperative method to mold custom-made implants for immediate single-stage or delayed cranioplasty. Data were collected from patients in whom cranioplasty became necessary after removal of bone flaps affected by intracranial infection, tumor invasion, or trauma. A PMMA replica was cast between a negative form of the patient's own bone flap and the original bone flap with exactly the same shape, thickness, and dimensions. Clinical and radiological follow-up was performed 2months post-surgery. Patient satisfaction (Odom criteria) and cosmesis (visual analogue scale for cosmesis) were evaluated 1 to 3years after cranioplasty. Twenty-seven patients underwent intraoperative template-molded patient-specific cranioplasty with PMMA. The indications for cranioplasty included bone flap infection (56%, n = 15), calvarian tumor resection (37%, n = 10), and defect after trauma (7%, n = 2). The mean duration of the molding procedure was 19 ± 7min. Excellent radiological implant alignment was achieved in 94% of the cases. All (n = 23) but one patient rated the cosmetic outcome (mean 1.4years after cranioplasty) as excellent (70%, n = 16) or good (26%, n = 6). Intraoperative cast-molded reconstructive cranioplasty is a feasible, accurate, fast, and cost-efficient technique that results in excellent cosmetic outcomes, even with large and complex skull defects