Computer-guided cranioplasty using ultra-high molecular weight polyethylene patient-specific implants: a case series

IntroductionCranioplasty is the surgical correction of a cranial defect. Three-dimensional software designs have allowed patient-specific single-step cranial reconstruction for neuroprotection and cosmesis. Ultra-high molecular weight polyethylene for partial or total bone replacement has been recently introduced as a promising material for cranioplasty. The objectives of this study are to evaluate the complications and esthetic results concerning the use of ultra-high molecular weight polyethylene patient-specific implants in craniectomy patients.MethodsWe report a series of nine patients with cranial defects from a previous craniectomy, or patients eligible for simultaneous craniectomy and cranioplasty via computer designed ultra-high molecular weight polyethylene patient-specific implants. We have analyzed the complications and cosmetic outcomes over a course of six months.ResultsNone of the cases developed infection, extra/subdural hematoma, cerebrospinal fluid leak, or implant failure. Three cases had postoperative sequalae: The first patient had mild postoperative seroma which subsided after medical therapy and compression, the second showed wound breakdown due to tumor metastasis and recurrence but did not necessitate implant removal, while the third sequela was a subgaleal hematoma which was aspirated, and the patient healed uneventfully afterward. Esthetic results were highly satisfactory in 75% of the patients (good patient acceptance without touch-ups).ConclusionUltra-high molecular weight polyethylene is in all respects suitable for primary and secondary cranioplasty, combined with computer-aided manufacturing-computer-aided design techniques, excellent esthetic and functional results were achieved. However, proper preoperative planning is important, and we recommend further prospective studies with larger number of patients followed up for longer periods for better assessment.