Page 205 - Clinical relevance of current materials for cranial implants
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                                Phase IV: All patients and surgeons will prefer a cranioplasty that has the highest accuracy, reliability and least complications. For this purpose a 3D scan (e.g. a CT scan or a MRI scan) of the cranial defect should be loaded in a dedicated computer program to design the optimal cranioplasty with a perfect fit and perfect aesthetics. Ideally, such a program should be able to virtually create the optimal cranial implant without human input. This might be possible with the use of novel algorithms using statistical shape models26. Databases containing 3D data of a large number of healthy controls forms the bases for such a shape model. The available 3D data of the patient to be treated can be automatically analyzed using the developed statistical model. The statistical model will provide the optimal implant to cover the defect and create the 3D design of the implant automatically. After the implant has been created automatically in the computer program the design and fit in the skull defect can be demonstrated to the patient. Finally, a soft tissue simulation should be created by the computer program to illustrate to the patient how the esthetical outcome will be after surgery.
Phase V: Immediately after the design of the cranioplasty has been completed stem cells of the patient will be used for the production of the cranioplasty. This is combined with the artificial / newly developed extracellular matrix or mineral components of bone in a specially developed bioprinter and results in a cranioplasty made out of the patient’s own material.
Phase VI: During the re-opening of the cranial defect, the cranioplasty that has been manufactured using bioprinting can be inserted in the defect. The fixation of the cranioplasty to the skull will be without fixation of screws, but with the use of osteogenesis the cranioplasty will fixed soon to the surrounding bone.
Conclusion
This thesis has answered some important research questions and brought new insights on materials currently used for cranioplasties. Further standardization of definitions, diagnostic criteria, complications, standardized treatment protocols, and outcome measurements are still needed to ensure an evidence-based choice for materials in cranioplasties. Technological innovations and the development of new materials will be an important factor in improving the treatment of cranial reconstructions. The ultimate goal is to find an ideal and safe cranioplasty material for both patients and healthcare workers, with a low infection rate and long-term protection of the brain, preferably with limited costs.
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General discussion and future perspectives
  



























































































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