University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Center for Global Design and Manufacturing, Department of Mechanical Engineering, University of Cincinnati, Cincinnati, OH, USA.
Acta Neurochir (Wien). 2023 Aug;165(8):2219-2224. doi: 10.1007/s00701-023-05663-x. Epub 2023 Jun 23.
Financial restrictions limit the options for hermetically precise, patient-specific cranial implants (PSCIs) after decompressive hemicraniectomy (DHC) in low-income countries. Use of image segmentation, modeling software, and 3D printers has lowered costs associated with PSCIs. However, requirements of time and technical expertise have prevented widespread utilization. Our objective was to create a fully automated software algorithm that is able to generate a virtual model (.STL) of a negative of an implant using CT imaging following DHC.
A freeware algorithm (CranialRebuild) was constructed with the following capabilities: (1) after the upload of digital imaging and communications in medicine files, the normal side is analyzed in reference to the side of DHC, (2) Boolean subtraction is used to obtain a virtual image of the desired implant, and (3) a two-piece virtual model (.STL) of the PSCI mold is generated. In four cadaveric specimens, a standard DHC was performed. Post-DHC CT imaging was used to obtain a .STL of the negative of the implant, which was then printed using poly-lactic acid (PLA). Methylmethacrylate cement was used to generate a PSCI from the mold. The PSCIs were implanted into the index specimens; cosmesis was subjectively evaluated using a 5-point Likert scale.
Two specimens were graded as 4/5, indicating that minor post-processing modification was needed for optimal cosmesis. Two specimens were graded as 3/5, indicating that optimal cosmesis could be obtained following moderate post-processing modification.
CranialRebuild can be used to create hermetically precise PSCIs at a fraction of the price of third-party vendors. Validation of this technology has significant implications for the accessibility of customized cranial implants worldwide.
在低收入国家，由于经济限制，去骨瓣减压术后（DHC）患者无法使用密封精确、个体化的颅骨植入物（PSCIs）。使用图像分割、建模软件和 3D 打印机可以降低 PSCIs 的成本。然而，时间和技术专业知识的要求阻碍了其广泛应用。我们的目标是创建一个全自动软件算法，该算法能够使用 DHC 后的 CT 成像生成植入物负模的虚拟模型（.STL）。
构建了一个免费软件算法（CranialRebuild），具有以下功能：（1）在上传数字成像和通信文件后，分析正常侧以参考 DHC 侧；（2）使用布尔减法获得所需植入物的虚拟图像；（3）生成两部分 PSCI 模具的虚拟模型（.STL）。在四个尸体标本中进行了标准的 DHC。使用 DHC 后的 CT 成像获取植入物负模的.STL，然后使用聚乳酸（PLA）打印。使用甲基丙烯酸甲酯水泥从模具中生成 PSCI。将 PSCIs 植入索引标本；使用 5 分制 Likert 量表对美容效果进行主观评估。
两个标本被评为 4/5，表明需要进行少量后期处理修改以达到最佳美容效果。两个标本被评为 3/5，表明经过适度的后期处理修改可以获得最佳美容效果。
CranialRebuild 可用于以第三方供应商价格的一小部分创建密封精确的 PSCIs。该技术的验证对全球定制颅骨植入物的可及性具有重要意义。
