Immediate single-stage cranioplasty following calvarial resection for benign and malignant skull neoplasms using customized craniofacial implants

Jens U. Berli, Lauren Thomaier, Shuting Zhong, Judy Huang, Alfredo Quinones-Hinojosa, Michael Lim, Jon Weingart, Henry Brem, Chad R. Gordon

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Craniectomy defects following resection of calvarial lesions are most often reconstructed using on-table manufacturing. With the advent of computer-aided design/manufacturing and customized craniofacial implants (CCIs), there seems to be more suited alternatives. In this study, the authors report their institutional experience and outcome using immediate, single-stage, CCI-based reconstruction for benign and malignant skull neoplasm defects. Methods: A retrospective review of a prospectively maintained database of all implant cranioplasties performed between 2011 and 2014, by a single craniofacial surgeon at a tertiary academic medical institution was performed. Preoperative and postoperative computed tomography scans with 3D reconstruction were performed for the purpose of assessing adequate resection and reconstructive outcomes. Primary endpoints included length of surgery, predicted defect versus postoperative implant surface area, contour irregularities, and complications. Results: Of the 108 patients with cranioplasty identified, 7 patients were found to undergo immediate CCI-based reconstruction for calvarial neoplasms; 4 patients (4/7, 57%) presented with malignant pathology. All defects were >5cm2. As compared with their original size, all implants were modified intraoperatively between 0.2% and 40.8%, with a mean of 13.8%. With followup ranging between 1 and 16 months, there were no implant-related complications identified. The immediate and long-term aesthetic results, as well as patient satisfaction, were ideal. Conclusion: With this preliminary experience, the authors have successfully demonstrated that immediate customized implant reconstructive techniques, by way of intraoperative modification, are both safe and feasible for benign and malignant skull neoplasms. The authors believe that with wider acceptance of this multidisciplinary approach and increased surgeon familiarity, this technique will soon become the reconstructive standard of care.

Original languageEnglish (US)
Pages (from-to)1456-1462
Number of pages7
JournalJournal of Craniofacial Surgery
Issue number5
StatePublished - Jul 2015


  • Bone neoplasm
  • Calvarial reconstruction
  • Craniofacial surgery
  • Cranioplasty
  • Customized craniofacial implant
  • Polyetheretherketone
  • Polymethylmethacrylate
  • Single stage
  • Skull tumor

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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