Page 204 - Clinical relevance of current materials for cranial implants

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Chapter 10
A FUTURE CRANIOPLASY PATIENT CASE
In the future the planning phase and manufacturing of cranioplasties should be easier, faster and cheaper. This may be realized in the near future by the introduction of several innovative changes in the workflow from craniectomy to cranioplasty and beyond. This is exemplified in the following scenario:
Case: A patient gets involved in a car accident. During the ride in the ambulance to the hospital, the neurological situation deteriorates.
Phase I: If the ambulance were to have the mobile equipment to perform a 3D scan of the head, an intracranial hemorrhage can be diagnosed. On arrival at the hospital, the intracranial pressure is measured to determine whether a decompressive craniectomy is indicated. A decompressive craniectomy with the optimal circumference is performed to either remove the hemorrhage or to lower the elevated pressure.
Phase II: After decompressive craniectomy, a patient-specific early recovery program starts 22. This program ensures an optimal condition of the patient and an early recovery. This can be realized by means of an adjusted diet, optimum pain control, motivation to quit smoking and drink alcohol and a good sleeping rhythm to improve the patient’s condition, with or without a (virtual) physical therapist. This program helps to reduce hospital stay, reduce postoperative complications, avoid stress and reduce insulin resistance23. In the end this program reduces costs because of the limitation of the parameters described above.
Phase III: When the patient is neurologically stable and fit for surgery, the process of a new cranioplasty is started. First, a conversation with the patient and/or his family is needed to know the patient’s preferences concerning the choice of the material to be inserted. This helps in the decision for a material that best fits the patient, both literally and figuratively speaking24. Patients should be aware of the advantages and disadvantages of the available options for reconstruction to facilitate a shared decision-making process. In the future artificial intelligence could probably be used to support the decision-making process25.