Skull reconstruction after resection of bone tumors in a single surgical time by the association of the techniques of rapid prototyping and surgical navigation
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Presentation of a new cranioplasty technique employing a combination of two technologies: rapid prototyping and surgical navigation. This technique allows the reconstruction of the skull cap after the resection of a bone tumor in a single surgical time.
The neurosurgeon plans the craniotomy previously on the EximiusMed software, compatible with the Eximius Surgical Navigator, both from the company Artis Tecnologia (Brazil). The navigator imports the planning and guides the surgeon during the craniotomy. The simulation of the bone fault allows the virtual reconstruction of the skull cap and the production of a personalized modelling mold using the Magics—Materialise (Belgium)—software. The mold and a replica of the bone fault are made by rapid prototyping by the company Artis Tecnologia (Brazil) and shipped under sterile conditions to the surgical center. The PMMA prosthesis is produced during the surgical act with the help of a hand press.
The total time necessary for the planning and production of the modelling mold is four days. The precision of the mold is submillimetric and accurately reproduces the virtual reconstruction of the prosthesis. The production of the prosthesis during surgery takes until twenty minutes depending on the type of PMMA used. The modelling mold avoids contraction and dissipates the heat generated by the material’s exothermic reaction in the polymerization phase. The craniectomy is performed with precision over the drawing made with the help of the Eximius Surgical Navigator, according to the planned measurements. The replica of the bone fault serves to evaluate the adaptation of the prosthesis as a support for the perforations and the placement of screws and fixation plates, as per the surgeon’s discretion.
This technique allows the adequate oncologic treatment associated with a satisfactory aesthetic result, with precision, in a single surgical time, reducing time and costs.
KeywordsDecompressive craniectomy Rapid prototyping Surgical navigation Cranioplasty Craniotomy Reconstruction
We thank the medical team that executed the case which illustrates the new technique: Dr. Ítalo Caprano Suriano, Dr. Bruno Fernandes de Oliveira Santos and Dr. Samuel Salu (Federal University of Sao Paulo-UNIFESP).
Compliance with ethical standards
Conflict of interest
The authors whose names are listed immediately below certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Author names: Bruno Fernandes de Oliveira Santos. The authors whose names are listed immediately below report the following details of affiliation or involvement in an organization or entity with a financial or non-financial interest in the subject matter or materials discussed in this manuscript. Author names: Marcos Vinicius Marques Anchieta, Frederico Assis de Salles, Bruno Cassaro Dal’Ava and Marcelo Marques Quaresma. The authors above are developers of the technics described in the manuscript and shareholders of the company Artis Technologia, who made a donation of both the mold in rapid prototyping, as Eximius Surgical Navigator to the procedure. The surgery which illustrates the case was conducted in a university hospital of Medicine School of the Federal University of Sao Paulo-UNIFESP, which is public and free. There was no cost to the patient.
- 1.Krause-Titz UR, Warneke N, Freitag-Wolf S, Barth H, Mehdorn HM (2015) Factors influencing the outcome (GOS) in reconstructive cranioplasty. Neurosurg Rev 39(1):133–139Google Scholar
- 3.Wildmann G, Stoffener R, Bale R (2009) Errors and error management in image-guided cranimaxillofacial surgery. Oral Maxillofac Radiol 107(5):701–715Google Scholar
- 5.Chauhan H, Rao SG, Chandramurli BA, Sampath S (2011) Neuro-navigation: an adjunct in craniofacial surgeries: our experience. J Maxillofac Oral Surg 10(4):296–300Google Scholar
- 6.Bruneau M, Kamouni R, Schoovaerts F, Pouleau HB, De Witte O (2015) Simultaneous image-guided skull bone tumor resection and reconstruction with a preconstructed prosthesis based on an OsiriX virtual resection. Neurosurgery 11(4):484–490Google Scholar