Page 128 - Clinical relevance of current materials for cranial implants

126
Chapter 6
In a non-acute setting, as in tumor removal, a combined craniectomy and cranioplasty can be preoperatively planned with the use of CAD/CAM-CAS. In preoperative virtual planning, a resection template may be designed to enable a one-stage surgical procedure for resection and reconstruction with a PSI. This prevents a lidless period (in which the patient needs to wear a helmet), avoids the need for a second surgical procedure and may lower complication rates and costs. In this study, the accuracy of resection templates for cranioplasty is critically evaluated with the aim in developing a reliable fail-safe and time-sparing cranial reconstruction using CAD/CAM-CAS technology.
Material and Methods
Three consecutive patients underwent cranial resections and reconstructions with the use of resection templates, control templates and a pre-fabricated PSI of poly(ether ether ketone) (PEEK).
Patient one: This 60-year old female, underwent a right temporal decompressive craniectomy because of acute subdural hemorrhage after trauma. She used acenocoumarol for atrial fibrillation and has hypertension in her medical history. After 4 months, the patient was neurologically stable and underwent a cranial reconstruction with autologous bone which, was stored in a bone bank at -80°C. Twenty-two months after reinsertion of the autologous bone the patient complained about headache and vertigo. A CT-scan was performed and resorption of the autologous bone was observed (Figure 2A). Removal of the autologous bone was planned in the same procedure as the insertion of the PSI with the use of resection templates (Figure 2B, 2C). After the reconstruction, a post-operative CT-scan was acquired to verify the position of the implant (Figure 2D). A distance map was generated between the planned position of the PSI and the achieved location post-operatively for quantification of the result (Figure 2E).