Evaluation of implant properties, safety profile and clinical efficacy of patient-specific acrylic prosthesis in cranioplasty using 3D binderjet printed cranium model: A pilot study. (March 2021)

• Record Type: Journal Article
• Authors: Basu, Bikramjit; Bhaskar, Nitu; Barui, Srimanta; Sharma, Vidushi; Das, Soumitra; Govindarajan, Nikhil; Hegde, Pranoy; Perikal, Parichay J.; Antharasanahalli Shivakumar, Madhura; Khanapure, Kiran; Tekkatte Jagannatha, Aniruddha
• Is Part Of: Journal of clinical neuroscience. Volume 85(2021)
• Page Start: 132
• Page End: 142
• Publication Date: 2021-03
• Subjects: Decompressive craniectomy -- Cranium model -- 3D printing -- Polymethyl methacrylate -- Cranioplasty; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.12.020
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: 3D binderjet printing based design and fabrication of patient specific acrylic flap for cranioplasty is safe and restores cosmesis accurately as determined by Cranial index of symmetry. Clinically acceptable structural and mechanical properties of the PMMA implant could be obtained with our design protocol. The use of 3D binderjet printer and conventional casting of PMMA flap allows an affordable option for cranioplasty in a resource constrained setting. Abstract: There exists a significant demand to develop patient-specific prosthesis in reconstruction of cranial vaults after decompressive craniectomy. we report here, the outcomes of an unicentric pilot study on acrylic cranial prosthesis fabricated using a 3D printed cranium model with its clinically relevant mechanical properties. Methods: The semi-crystalline polymethyl methacrylate (PMMA) implants, shaped to the cranial defects of 3D printed cranium model, were implanted in 10 patients (mean age, 40.8 ± 14.8 years). A binderjet 3D printer was used to create patient-specific mould and PMMA was casted to fabricate prosthesis which was analyzed for microstructure and properties. Patients were followed up for allergy, infection and cosmesis for a period of 6 months. Results: As-cast PMMA flap exhibited hardness of 15.8 ± 0.24Hv, tensile strength of 30.7 ± 3.9 MPa and elastic modulus of 1.5 ± 0.1 GPa. 3D microstructure of the semi-crystalline acrylic implant revealed 2.5–15 µm spherical isolated pores. The mean area of the calvarial defect in craniectomy patients was 94.7 ± 17.4 cm 2 . We achieved a cranial index of symmetry (CIS -%) of 94.5 ± 3.9, while the average post-operative Glasgow outcome scale (GOS) score recorded was 4.2 ± 0.9. Conclusions: 3D printing based patient-specific design and fabrication of acrylic cranioplasty implant is safe and achieves acceptable cosmetic and clinical outcomes in patients with decompressive craniectomy. Our study ensured clinically acceptable structural and mechanical properties of implanted PMMA, suggesting that a low cost 3D printer based PMMA flap is an affordable option for cranioplasty in resource constrained settings.