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. 2021 Nov 12;7(1):35.
doi: 10.1186/s41205-021-00123-7.

3D printed customised external cranial plate in a patient with syndrome of trephined: 'a case report'

Mee H  1 , Greasley S  2 , Whiting G  3 , Harkin C  3 , Oliver G  4 , Marsden D  2 , Andrews R  2 , Sireau S  2 , Price Rd  5 , Anwar F  3 , Timofeev Is  3 , Hutchinson Pj  3 , White Pa  2 , Helmy A  3
Affiliations

3D printed customised external cranial plate in a patient with syndrome of trephined: 'a case report'

Mee H et al. 3D Print Med. .

Abstract

Background: Syndrome of the trephined is a well-recognised phenomenon that occurs in patients following a craniectomy. It is associated with several symptoms, including headaches, motor impairments, cognitive disorders and reduced consciousness. Treatment for the syndrome usually involves replacing the skull defect.

Case study: A 71-year-old male underwent a left-sided craniectomy after being diagnosed with biopsy-confirmed invasive squamous cell carcinoma with associated skull erosion. Subsequently, he developed a severe case of syndrome of the trephined (SoT,) resulting in having to lie flat to prevent the motor component of the Glasgow Coma Score (GCS) falling from M5/6 (E3/4 Vt M5/6) to M1 (E3/4 Vt M1) on sitting to 30 degrees. Unfortunately, due to ongoing chest sepsis and physical frailty, he was unable to undergo a cranioplasty. Therefore, to aid in clinical stabilisation, the treating physicians and clinical engineering teams designed and manufactured a prosthesis on-site, allowing rapid patient treatment. The prosthesis led to the patient being able to sit up to 30 degrees without the motor component of the GCS falling from M6 to M1 (E4 VT M6).

Conclusion: Clinical improvements were demonstrated with definitive neurological improvement after applying the external cranial plate in clinical outcome measures and radiographically. Furthermore, we have shown that rapid prototyping technology provides a flexible solution to synthesise bespoke medical prostheses with the correct expertise and regulatory framework.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Workflow from CT image file to printable STL file.
Fig. 2
Fig. 2
CT head scan with 3D reconstruction before device application
Fig. 3
Fig. 3
CT head scan with 3D reconstruction two days after device application. As the brain surface expands towards the inner surface of the cranioplasty, the ventricles become enlarged. This is an ex vacuo phenomenon and does not represent hydrocephalus
Fig. 4
Fig. 4
External cranioplasty before application
Fig. 5
Fig. 5
External plate after application
See this image and copyright information in PMC

References

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