Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar;22(1):65-69.
doi: 10.1007/s10006-017-0668-4. Epub 2018 Jan 8.

Considerations in computer-aided design for inlay cranioplasty: technical note

Erik Nout  1   2 , Maurice Y Mommaerts  3
Affiliations

Considerations in computer-aided design for inlay cranioplasty: technical note

Erik Nout et al. Oral Maxillofac Surg. 2018 Mar.

Abstract

Context: Cranioplasty is a frequently performed procedure that uses a variety of reconstruction materials and techniques. In this technical note, we present refinements of computer-aided design-computer-aided manufacturing inlay cranioplasty.

Objective, design, and setting: In an attempt to decrease complications related to polyether-ether-ketone (PEEK) cranioplasty, we gradually made changes to implant design and cranioplasty techniques. These changes include under-contouring of the implant and the use of segmented plates for large defects, microplate fixation for small temporal defects, temporal shell implants to reconstruct the temporalis muscle, and perforations to facilitate the drainage of blood and cerebrospinal fluid and serve as fixation points.

Results: From June 2016 to June 2017, 18 patients underwent cranioplasty, and a total of 31 PEEK and titanium implants were inserted. All implants were successful.

Conclusions: These changes to implant design and cranioplasty techniques facilitate the insertion and fixation of patient-specific cranial implants and improve esthetic outcomes.

Keywords: Computer-aided design; Cranium; Implant.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

Erik Nout declares that he has no conflict of interest.

Maurice Mommaerts declares that he is innovation manager at CADskills bvba.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical committee review was deemed not necessary as this is a study on product design not on clinical outcomes.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
The mirrored contour is slightly decreased (from red to beige) to allow for tensionless wound closure
Fig. 2
Fig. 2
The red arrows point at the space left between the caudal edge of the implant and the bony defect edge, under the temporalis muscle (stump). Dissection of the soft tissues to find the bony rim might otherwise jeopardize the greater vessels in the area (deep temporal and middle meningeal arteries)
Fig. 3
Fig. 3
Large defects still can be covered by a PEEK implant when two segments are CNC milled and connected in situ by the way of a 3D puzzle design (blue arrows)
Fig. 4
Fig. 4
The drainage holes are at the same time available for dura and temporalis muscle suspension
Fig. 5
Fig. 5
Angular holes at the perimeter are located such that drill and screwdriver access are not hindered, and the superior sagittal sinus and venous lakes are not endangered
Fig. 6
Fig. 6
The implant border may receive too much strain from the angular fixation screw and chip off, when a biconcave washer (green) is not used to redirect the exerted force towards the screw shaft
Fig. 7
Fig. 7
Distribution of strain upon traumatic impact by an overlapping border (yellow)
Fig. 8
Fig. 8
An extra implant (lila arrow) to prevent temporal hour glass deformity
See this image and copyright information in PMC

Comment in

References

    1. Bonda DJ, Manjila S, Selman W, Dean D. The recent revolution in the design and manufacture of cranial implants: modern advancements and future directions. Neurosurgery. 2015;77(5):814–824. doi: 10.1227/NEU.0000000000000899. - DOI - PMC - PubMed
    1. Joseph V, Reilly P. Syndrome of the trephined. J Neurosurg. 2009;111(4):650–652. doi: 10.3171/2009.3.JNS0984. - DOI - PubMed
    1. Jaberi J, Gambrell K, Tiwana P, Madden C, Finn R. Long-term clinical outcome analysis of poly-methyl-methacrylate cranioplasty for large skull defects. J Oral Maxillofac Surg. 2013;71(2):e81–e88. doi: 10.1016/j.joms.2012.09.023. - DOI - PubMed
    1. Wauters LDJ, San Miguel-Moragas J, Mommaerts MY. Classification of computer-aided design–computer-aided manufacturing application for the reconstruction of cranio-maxillo-facial defects. J Craniofac Surg. 2015;26(8):2329–2333. doi: 10.1097/SCS.0000000000001845. - DOI - PubMed
    1. Jonkergouw J, van de Vijfeijken SE, Nout E, Theys T, Van de Casteele E, Folkersma H, Depauw PR, Becking AG. Outcome in patient-specific PEEK cranioplasty: a two-center cohort study of 40 implants. J Craniomaxillofac Surg. 2016;44(9):1266–1272. doi: 10.1016/j.jcms.2016.07.005. - DOI - PubMed

LinkOut - more resources