Do-It-Yourself Cranioplasty—3D Printers Help to Reduce Costs and Enhance Cosmetic Results of Cranioplasty

Aims: To display the development and the systematic implementation into daily routine of a new three-dimensional (3D) printer assisted method to perform patient-specific implants for cranioplasty.

Method: Case series of six patients consecutively operated at the University Hospital of Basel using a 3D print hybrid technique to perform patient-specific cranioplasty. A design optimization software (3-matic, version 11.0, Materialise Inc., Leuven, Belgium) was used to process digital imaging and communications in medicine. Data from the patient’s preoperative cranial computed tomography and a template of the bony defect was then printed out with a commercially available high-end 3D printer (Stratasys Objet 30 Prime, Stratasys GmbH, Rheinmünster, Germany). As a printing substrate, a biocompatible substrate, MED610, was used. The printed-out template of the future implant is required to form a mold using a heat-resistant addition-type silicone material (PRESIDENT soft putty, Coltène/ Whaledent AG, Altstätten, Switzerland) that is routinely used in craniomaxillofacial surgery which is then sterilized to produce the implantable patient-specific polymethylmethacrylate (PMMA) implant.

Results: We present the workflow from printing a template of the bone flap to the construction of the silicone mold and sterile implantation of the patient-specific implant made of PMMA.

A cost analysis will be presented compared with commercially available patient-specific implants.

Conclusions: Systematic implementation of the in-hospital production of 3D printer assisted patient-specific implants made of conventional Palacos (PMMA) is safe, feasible and markedly helps to reduce treatment costs with yet excellent cosmetic results compared with conventional PMMA cranioplasty.