Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
Department of Oral & Cranio-Maxillo-Facial Surgery and 3D Print Lab, University Hospital of Basel, Basel, Switzerland.
Neurosurg Rev. 2023 Apr 19;46(1):93. doi: 10.1007/s10143-023-02000-9.
Various cranioplasty techniques exist for the reconstruction of cranial bone defects. Patient-specific implants can be produced in-house using a recently developed 3D printer-assisted cranioplasty technique. However, the resulting cosmetic outcomes from the patient's perspective are underreported. With our case series, we aim to present the clinical outcome, morbidity rate, patient-reported cosmetic results, and cost-effectiveness of patient-specific3D printer-assisted cranioplasty technique. This is a consecutive retrospective case series of adult patients undergoing cranioplasty using the patient-specific 3D printer-assisted technique. As primary endpoint, the functional outcome based on modified Rankin scale (mRS) at discharge and follow-up was assessed. A prospective telephone survey was conducted to collect and provide patient-reported outcomes. Thirty-one patients underwent patient-specific 3D printer-assisted cranioplasty, mostly to reconstruct frontotemporoparietal (61.3%) and frontotemporal defects with orbital involvement (19.4%). Good functional outcome (mRS ≤ 2) at discharge and during the last follow-up was achieved in 54.8% (n = 17) and 58.1% (n = 18) patients. Overall, the rate of clinically relevant surgery-related complications was 35.5% (n = 11). Postoperative epidural hematoma/collection (16.1%) and infections (12.9%) were the most frequent complications. Permanent morbidity occurred in one patient (3.2%) with postoperative acute ipsilateral vision loss after frontotemporal cranioplasty with orbital involvement. No surgery-related mortality occurred. The mean patient-reported cosmetic satisfaction score was 7.8 ± 1.5, with 80% of patients reporting satisfying or very satisfying cosmetic results. No significant differences were seen between the different defect localization regarding the cosmetic outcome. The mean manufacturing costs of a patient-specific 3D printer-assisted implant ranged from 748 to 1129 USD. Based on our case series, patient-specific 3D printer-assisted cranioplasty is cost-effective and leads to satisfying cosmetic results, especially in large defects and/or defects with complex geometry.
各种颅骨成形技术可用于重建颅骨缺损。使用最近开发的 3D 打印机辅助颅骨成形技术，可以在内部生产患者特异性植入物。然而，从患者的角度来看，由此产生的美容效果报道较少。通过我们的病例系列，我们旨在展示患者特异性 3D 打印机辅助颅骨成形技术的临床结果、发病率、患者报告的美容结果和成本效益。这是一项使用患者特异性 3D 打印机辅助技术进行颅骨成形术的成人患者连续回顾性病例系列。主要终点是基于改良 Rankin 量表（mRS）在出院和随访时的功能结果进行评估。前瞻性电话调查用于收集和提供患者报告的结果。31 例患者接受了患者特异性 3D 打印机辅助颅骨成形术，主要用于重建额颞顶枕部（61.3%）和额颞部伴眶部受累（19.4%）的缺陷。54.8%（n=17）和 58.1%（n=18）的患者在出院和最后一次随访时获得了良好的功能结果（mRS≤2）。总体而言，有临床意义的手术相关并发症发生率为 35.5%（n=11）。术后硬膜外血肿/积聚（16.1%）和感染（12.9%）是最常见的并发症。在 1 例（3.2%）患者中发生了永久性并发症，该患者在额颞部伴眶部受累的颅骨成形术后出现急性同侧视力丧失。无手术相关死亡。患者报告的美容满意度平均评分为 7.8±1.5，80%的患者报告美容效果满意或非常满意。不同缺陷定位之间的美容结果没有显著差异。患者特异性 3D 打印机辅助植入物的平均制造成本为 748 至 1129 美元。基于我们的病例系列，患者特异性 3D 打印机辅助颅骨成形术具有成本效益，并可获得令人满意的美容效果，尤其是在大缺陷和/或具有复杂几何形状的缺陷中。
