A prospective study of computer-aided design and manufacture of titanium plate for cranioplasty and its clinical outcome

TLDR

The study describes using computerized 3‑D imaging and automated milling to produce accurate titanium plates for craniofacial defect reconstruction. CAD/CAM titanium plates were fabricated and implanted in 148 patients—141 secondary and 7 single‑stage cranioplasties—assessing fit, skull contour, aesthetics, and reviewing 72 patients after one year for symptom impact. Excellent or good intraoperative fit was achieved in 97 % of plates, with a median insertion time of 15 minutes, 98 % restoring natural skull shape and symmetry, and 82 % of patients experiencing complete or reduced adverse symptoms after one year. One plate was temporarily removed due to a staphylococcus infection.

Abstract

AbstractThe use of computerized three dimensional imaging and automated milling of models to produce accurate titanium plates for the reconstruction of craniofacial defects is described. A total of 148 patients have had extensive calvarial defects repaired using this (computer aided design and manufacture) technique developed in our unit. Of these, 141 were repaired secondarily (delayed cranioplasty), whilst seven were repaired immediately following craniectomy (single stage cranioplasty). All cases were assessed for accuracy of fit, restoration of natural skull contour and aesthetics. Seventy-two patients were reviewed after 1 year to determine the effect on adverse preoperative symptoms. Of the plates 97% had an excellent or good intraoperative fit. The modal insertion time was only 15 minutes. Postoperatively 98% resulted in the restoration of natural skull shape and symmetry. After 1 year, 82% of patients had complete resolution or diminution in severity of the adverse symptoms. A staphylococcus infection necessitated the temporary removal of one plate.KeywordsComputer Controlled Milling;Primary Cranioplasty;Secondary Cranioplasty;3d Imaging