A novel prefabricated patient-specific titanium cranioplasty: reconsideration from a traditional approach

Patient-specific implants (PSI) for cranioplasty are expensive, and cost remains the limiting factor in low- to middle-income countries. The authors describe a novel, reproducible and cost-effective method of designing prefabricated titanium PSI cranioplasty. Ten patients from June 2018 to December 2020 were included in this retrospective study. A three-dimensional stereolithography model was made on a custom-built 3D printer with variable layer heights to produce efficient and accurate details. A certain amount of defect in the temporal region was left uncovered to avoid complications related to temporalis muscle dissection. The stereolithography model with a cranial defect was reconstructed with modelling wax. The wax model was scanned with a blue light visible scanner. The digital data was transferred to the milling machine (Jayon Surgical®, Kerala, India), where a 1-mm-thick sheet of titanium was milled according to the specifications. RFCC scoring system was used for assessing cosmetic outcome. The mean duration of the surgery was 56.50 min, SD = 14.916 min (range 45–75 min). In 9/10 patients, the RFCC score was 4 points. No other complications were found at a minimum follow-up of 18 months in all patients. The cost per patient was approximately 30,000 INR or 400 US dollars. The average time required for us to get the PSI ready for surgery was about 15 days. The authors demonstrate a novel, cost-effective and reproducible method of PSI using titanium for cranioplasty.