Polylactic Acid Implant for Cranioplasty with 3-dimensional Printing Customization: A Case Report

Tedy  Apriawan; Khrisna Rangga Permana; Ditto Darlan; Muhammad Reza  Arifianto; Fitra Fitra; Asra  Alfauzi; Abdul Hafid  Bajamal

doi:10.3889/oamjms.2020.5156

Authors

Tedy Apriawan Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Khrisna Rangga Permana Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Ditto Darlan Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Muhammad Reza Arifianto Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Fitra Fitra Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Asra Alfauzi Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Abdul Hafid Bajamal Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.5156

Keywords:

Cranioplasty, Polylactic acid, Skull defect, 3-dimensional print

Abstract

BACKGROUND: Cranioplasty is aimed to restore the structure and function of the lost portion of the skull defect. Many materials can be used for cranioplasty, such as the bones of the patient (autograft), the bones of other patients (allograft), bones of animals (xenograft), or synthetic materials such as acrylic or titanium mesh. These materials are quite expensive and sometimes require complex processes. Manual shaping of material for cranioplasty is also quite time-consuming and prone to cause esthetic dissatisfaction. The author will discuss the case of using polylactic acid (PLA) implant with 3-dimensional (3D) printing customization as a cheap and accurate cosmetic solution for cranioplasty procedures.

CASE REPORT: We report 2 cases of skull defect underwent cranioplasty. The first case, female, 20-year-old, had a history of severe traumatic brain injury (TBI) and epidural hematoma. She underwent decompression craniotomy on the left frontotemporoparietal region of her skull. The second case, male, 46-year-old, had a history of spontaneous intracerebral hemorrhage due to arteriovenous malformation (AVM). He underwent decompression craniotomy on the right frontotemporoparietal region of her skull. Both the data of computerized tomography (CT) scan were reconstructed to get 3D model of skull defect. Prosthesis was made by 3D printer accordingly using PLA as material. There was no complication reported postoperatively and cosmetic satisfaction was obtained on both cases.

CONCLUSION: The use of PLA implant with 3D printing customization was proved to be cost-effective and good cosmetic satisfaction with no complication reported following cranioplasty procedure.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Mostafa Elkatatny AA, Eldabaa KA. Cranioplasty: A new perspective. Open Access Maced J Med Sci. 2019;7(13):2093- 101. https://doi.org/10.3889/oamjms.2019.489 PMid:31456832 DOI: https://doi.org/10.3889/oamjms.2019.489

Shah AM, Jung H, Skirboll S. Materials used in cranioplasty: A history and analysis. Neurosurg Focus. 2014;36(4):E19. https:// doi.org/10.3171/2014.2.focus13561 PMid:24684331 DOI: https://doi.org/10.3171/2014.2.FOCUS13561

Sürme MB. Cranioplasty with preoperatively customized polymethyl-methacrylate by using 3-dimensional printed polyethylene terephthalate glycol mold. J Neurosci Neurol Disord. 2018;2:52-64. https://doi.org/10.29328/journal. jnnd.1001016 DOI: https://doi.org/10.29328/journal.jnnd.1001016

Aydin S, Kucukyuruk B, Abuzayed B, Aydin S, Sanus GZ. Cranioplasty: Review of materials and techniques. J Neurosci Rural Pract. 2011;2(2):162-7. https://doi. org/10.4103/0976-3147.83584 PMid:21897681 DOI: https://doi.org/10.4103/0976-3147.83584

Yu Q, Chen L, Qiu Z, Zhang Y, Song T, Cui F. Skull repair materials applied in cranioplasty: History and progress. Transl Neurosci Clin. 2017;3(1):48-57. https://doi.org/10.18679/ cn11-6030/r.2017.007 DOI: https://doi.org/10.18679/CN11-6030/R.2017.007

Blasi P. Poly(lactic acid)/poly(lactic-co-glycolic acid)-based microparticles: An overview. J Pharm Invest. 2019;49:337-46. https://doi.org/10.1007/s40005-019-00453-z DOI: https://doi.org/10.1007/s40005-019-00453-z

Sharma S, Goel SA. 3D printing and its future in medical world. J Med Res Innov. 2018;3(1):e000141. https://doi.org/10.15419/ jmri.141 DOI: https://doi.org/10.15419/jmri.141

Chae MP, Rozen WM, McMenamin PG, Findlay MW, Spychal RT, Hunter-Smith DJ. Emerging applications of bedside 3D printing in plastic surgery. Front Surg. 2015;2:25. https://doi. org/10.3389/fsurg.2015.00025 PMid:26137465 DOI: https://doi.org/10.3389/fsurg.2015.00025

Hatamleh MM, Cartmill M, Watson J. Management of extensive frontal cranioplasty defects. J Craniofac Surg. 2013;24(6):2018-22. PMid: 24220395 DOI: https://doi.org/10.1097/SCS.0b013e3182a41bcc

Peel S, Eggbeer D, Burton H, Hanson H, Evans PL. Additively manufactured versus conventionally pressed cranioplasty implants: An accuracy comparison. Proc Inst Mech Eng H. 232(9):949-61. https://doi.org/10.1177/0954411918794718 DOI: https://doi.org/10.1177/0954411918794718

Peel, S. & Eggbeer, D. Additively manufactured maxillofacial implants and guides-Achieving routine use. Rapid Prototyp J. 2016;22(1):189-99. https://doi.org/10.1108/rpj-01-2014-0004 DOI: https://doi.org/10.1108/RPJ-01-2014-0004

Pawar RP, Tekale SU, Shisodia SU, Totre JT, Domb AJ. Biomedical applications of poly(lactic acid). Recent Pat Regen Med. 2014;4(1):40-51. https://doi.org/10.2174/2210296504666 140402235024 DOI: https://doi.org/10.2174/2210296504666140402235024

Marek AA, Verney V. Photochemical reactivity of PLA at the vicinity of glass transition temperature. The photo-rheology method. Eur Polym J. 2016;81:239-46. https://doi.org/10.1016/j. eurpolymj.2016.06.016 DOI: https://doi.org/10.1016/j.eurpolymj.2016.06.016

Oth O, Dauchot C, Orellana M, Glineur R. How to sterilize 3D printed objects for surgical use? An evaluation of the volumetric deformation of 3D-printed genioplasty guide in PLA and PETG after sterilization by low-temperature hydrogen peroxide gas plasma. Open Dent J. 2019;13(1):410-7. https://doi. org/10.2174/1874210601913010410 DOI: https://doi.org/10.2174/1874210601913010410

Turvey TA, Bell RB, Tejera TJ, Proffit WR. The use of self-reinforced biodegradable bone plates and screws in orthognathic surgery. J Oral Maxillofac Surg. 2002;60(1):59-65. https://doi. org/10.1053/joms.2002.28274 PMid:11757010 DOI: https://doi.org/10.1053/joms.2002.28274

Böstman O, Pihlajamäki H. Clinical biocompatibility of biodegradable orthopaedic implants for internal fixation: A review. Biomaterials. 2000;21(24):2615-21. https://doi. org/10.1016/s0142-9612(00)00129-0 PMid:11071611 DOI: https://doi.org/10.1016/S0142-9612(00)00129-0

Choi HJ, Kim W, Youn S, Lee JH. Management of delayed infection after insertion of bioresorbable plates at the infraorbital rim. J Craniofac Surg. 2012;23(2):524-5. https://doi.org/10.1097/ scs.0b013e31824cd4de PMid:22421862 DOI: https://doi.org/10.1097/SCS.0b013e31824cd4de

Kim YY, Rhyu KW. Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture. Eur Spine J. 2010;19(11):1907-12. https://doi. org/10.1007/s00586-010-1479-6 PMid:20559850 DOI: https://doi.org/10.1007/s00586-010-1479-6

Kim YM, Lee JH. Clinical courses and degradation patterns of absorbable plates in facial bone fracture patients. Arch Craniofac Surg. 2019;20(5):297-303. https://doi.org/10.7181/ acfs.2019.00409 PMid:31658793 DOI: https://doi.org/10.7181/acfs.2019.00409

Farah S, Anderson DG, Langer R. Physical and mechanical properties of PLA, and their functions in widespread applications-a comprehensive review. Adv Drug Deliv Rev. 2016;107:367-92. https://doi.org/10.1016/j.addr.2016.06.012 DOI: https://doi.org/10.1016/j.addr.2016.06.012

Staffa G, Nataloni A, Compagnone C, Servadei F. Custom made cranioplasty prostheses in porous hydroxy-apatite using 3D design techniques: 7 years experience in 25 patients. Acta Neurochir (Wien). 20007;149(2):161-70. https://doi.org/10.1007/ s00701-006-1078-9 PMid:17242849 DOI: https://doi.org/10.1007/s00701-006-1078-9

Lemée JM, Petit D, Splingard M, Menei P. Autologous bone flap versus hydroxyapatite prosthesis in first intention in secondary cranioplasty after decompressive craniectomy: A French medico-economical study. Neurochirurgie. 2013;59(2):60-3. https://doi.org/10.1016/j.neuchi.2012.10.138 DOI: https://doi.org/10.1016/j.neuchi.2012.10.138

O’Reilly EB, Barnett S, Madden C, Welch B, Mickey B, Rozen S. Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty. J Plast Reconstr Aesthet Surg. 2015;68(3):329-38. https://doi.org/10.1016/j.bjps.2014.11.001 PMid:25541423 DOI: https://doi.org/10.1016/j.bjps.2014.11.001

Binhammer A, Jakubowski J, Antonyshyn O, Binhammer P. Comparative cost-effectiveness of cranioplasty implants. Plast Surg (Oakv). 2020;28(1):29-39. https://doi. org/10.1177/2292550319880922 PMid:32110643 DOI: https://doi.org/10.1177/2292550319880922

Tan ET, Ling JM, Dinesh SK. The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer. J Neurosurg. 2016;124(5):1531-7. https://doi. org/10.3171/2015.5.jns15119 PMid:26566203 DOI: https://doi.org/10.3171/2015.5.JNS15119

Morales-Gómez JA, Garcia-Estrada E, Leos-Bortoni JE, Delgado-Brito M, Flores-Huerta LE, De La Cruz-Arriaga AA, et al. Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer. J Neurosurg. 2018;130:1-7. https://doi.org/10.3171/2017.12.jns172574 PMid:29905512 DOI: https://doi.org/10.3171/2017.12.JNS172574