Acta Neurochirurgica

, Volume 156, Issue 4, pp 793–803 | Cite as

Intraoperative fabrication of patient-specific moulded implants for skull reconstruction: single-centre experience of 28 cases

  • Lennart Henning StieglitzEmail author
  • Nicolas Gerber
  • Thomas Schmid
  • Pasquale Mordasini
  • Jens Fichtner
  • Christian Fung
  • Michael Murek
  • Stefan Weber
  • Andreas Raabe
  • Jürgen Beck
Clinical Article - Neurosurgical Techniques



Intraoperatively fabricated polymethylmethacrylate (PMMA) implants based on computer-designed moulds were used to improve cosmetic results after hard tissue replacement. To assess the implant’s cosmetic and functional results we performed both subjective and objective assessments.


This retrospective analysis was performed using a cohort of 28 patients who received PMMA implants between February 2009 and March 2012. The cosmetic and functional results were assessed using a patient questionnaire. Furthermore an objective volumetric subtraction score (0–100) was applied and implant thickness, as well as gaps and tiers, were measured.


Patients mainly judged their cosmetic result as “good”. Two of the 28 patients found their cosmetic result unfavourable. The functional result and stability was mainly judged to be good. Measurements of implant thickness showed a very high correlation with the thickness of the contralateral bone. Volumetric subtraction led to a median quality of 80 on a scale from 0 to 100. Median gaps around the margins of the implant were 1.5 mm parietally, 1.7 mm frontally and 3.5 mm fronto-orbitally, and median tiers were 1.2 mm, 0 mm and 0 mm respectively. The overall rate of surgical revisions was 10.7 % (three patients). Two patients suffered from wound healing disturbances (7.1 %). The overall complication rate was comparable to other reports in the literature.


Implantation of intraoperatively fabricated patient-specific moulded implants is a cost-effective and safe technique leading to good clinical results with a low complication rate.


hemicraniectomy PMMA PSI PSMI Skull reconstruction 


Disclosure of funding

No specific funding was received for this research.

Conflicts of interest



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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Lennart Henning Stieglitz
    • 1
    Email author
  • Nicolas Gerber
    • 2
  • Thomas Schmid
    • 3
  • Pasquale Mordasini
    • 4
  • Jens Fichtner
    • 1
  • Christian Fung
    • 1
  • Michael Murek
    • 1
  • Stefan Weber
    • 2
  • Andreas Raabe
    • 1
  • Jürgen Beck
    • 1
  1. 1.Department of NeurosurgeryBern University HospitalBernSwitzerland
  2. 2.ARTORG-ISTBUniversity of BernBernSwitzerland
  3. 3.University of BernBernSwitzerland
  4. 4.Diagnostic and Interventional NeuroradiologyBern University HospitalBernSwitzerland

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