Template Routed Patient-Specific Implant for 1-Stage Cranioplasty

Abstract

BACKGROUND AND OBJECTIVES: Cranial reconstruction presents a significant challenge in cases involving pathologies with skull invasion, and various techniques have been used, including the intraoperative shaping of titanium mesh and the manual sculpting of bone cement serving as surrogates for the excised bone graft. In the context of prefabricated patient-specific implants (PSIs) for cranioplasty, precise surgical execution of craniotomies is paramount. This ensures optimal congruity between the implant and the defect created during the craniotomy, leading to a successful single-stage procedure encompassing both bone removal and reconstruction. This article presents a meticulous method for achieving such high-fidelity craniotomy and subsequent cranioplasty using PSIs in a single-stage surgery. METHODS: The procedure was implemented for 2 cases of meningiomas with osseous invasion. Through meticulous preoperative planning, the craniotomy template and implant were designed using computer-assisted design and manufactured on a 3-dimensional printer using the patient's computed tomography scans. Intraoperative fabrication of sterile polymethyl methacrylate replicas was achieved through the creation of silicone molds and subsequent injection molding techniques. Predesignated screw holes facilitated neuronavigation-assisted positioning of the template, aligning it accurately with the target site using registration points. Mini-screws firmly secured the template to the skull. Guided by the template, a craniotomy router performed the bone resection. On completion, the implant was affixed into place using plates and screws. RESULTS: This technique demonstrably facilitated a cost-effective, streamlined and precise application of prefabricated PSIs within a single-stage craniotomy-cranioplasty procedure. Subjective patient reports indicated high levels of satisfaction with the outcome. CONCLUSION: The template routed patient-specific implant 1-stage cranioplasty technique refines previous approaches through precise template localization on the skull, enabling an accurate craniotomy to match a prefabricated PSI. This single-stage procedure rivals hand-shaped methods in aesthetics and compares with the outcomes of 2-stage PSI cranioplasties. Additional studies are needed to validate our results.