Patient-specific reconstruction utilizing computer assisted 3D modelling for partial bone flap defect in hybrid cranioplasty Open Access

Autologous cranioplasty using a patient’s original bone flap remain the commonest practice nowadays. However, partial bone flap defect is commonly encountered. Replacing the bone flap with pre-moulded synthetic bone flap is costly and not affordable to many patients. Hence most of the small to medium size defect was topped up with alloplastic material on a free hand basis intra-operatively which often resulted in inaccurate implant approximation with unsatisfactory cosmetic result. This study aims to evaluate implant accuracy and cosmetic outcome of cranioplasty candidates who underwent partial bone flap reconstruction utilising computer assisted 3D modelling. 3D images of the skull were obtained from post-craniectomy axial 1-mm spiral computed tomography (CT) scans and a virtual 3D model was generated using the Materialise Mimics software. The Materialise 3-Matic was then utilised to design a patient-specific implant. Prefabrication of the implant was performed by the 3D Objet printer, and a negative gypsum mold was created with the prefabricated cranial implant. Intraoperatively, a hybrid polymethyl methacrylate (PMMA)-autologous cranial implant was produced using the gypsum mold, and fit into the cranial defect. This study is still ongoing at the moment. To date, two men has underwent partial bone flap reconstruction utilising this technique and both revealed satisfactory implant alignment with favourable cosmesis. Mean implant size was 12cm², and the mean duration of intraoperative reconstruction for the partial bone flap defect was 40 minutes. No significant complication was reported. As a conclusion, this new technique and approach resulted in satisfactory implant alignment and favourable cosmetic outcome. However, more study samples are needed to increase the validity of the study results.