TY - JOUR
T1 - Quantitative analysis of dual-purpose, patient-specific craniofacial implants for correction of temporal deformity
AU - Zhong, Shuting
AU - Huang, Gary J.
AU - Susarla, Srinivas M.
AU - Swanson, Edward W.
AU - Huang, Judy
AU - Gordon, Chad R.
N1 - Funding Information:
Funding for this study was provided in part by a research grant provided by Stryker Craniomaxillofacial (Kalamazoo, MI). Dr Gordon is paid consultant for Stryker. He is also entitled under a private consulting agreement with Stryker Craniomaxillofacial (Kalamazoo, MI) to potential royalties on an invention described in this article. These arrangements have been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Funding Information:
The authors thank Jason Smith, BS, BA, John Bryndza, MS, Garret Campbell, BSME, and Kevin Cordero, MS, for their assistance in coordinating this study.
Publisher Copyright:
Copyright © 2015 by the Congress of Neurological Surgeons.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - BACKGROUND: The development of computer-assisted design, virtual modeling, and computed tomography has allowed precise customization of implants for patients who undergo neurosurgical or craniofacial surgery procedures. However, such techniques and implant designs have not adequately addressed temporal asymmetry due to postoperative bone resorption, temporalis muscle malposition/foreshortening, and/or temporal fat pad atrophy. OBJECTIVE: We hypothesized that an alteration in customized craniofacial implant (CCI) design with a strategic extension inferolaterally and excessive material bulking would provide simultaneous reconstruction of coexisting temporal skull defects and therefore reduce the effect of soft tissue deformities. METHODS: A single-surgeon, single-institution retrospective cohort study was performed to include 10 consecutive subjects who underwent cranioplasty reconstruction with modified implants during a 3-year period. Implants were placed with the use of our previously described pericranial-onlay technique. With the use of a computed tomography-based, computer-assisted design/manufacturing methodology, novel dual-purpose implants were designed to prevent and/or correct persistent temporal hollowing. The efficacy of the new CCI shape and design for cranial restoration of temporal symmetry was analyzed in both 2 and 3 dimensions. RESULTS: In 2-dimensional analyses, the modified implant provided enhanced lateral projection (21%; 1.06 cm) in areas closest to the temporal arch. Three-dimensional volumetric analyses demonstrated that additional bulking totaled 24 6 11 cm3 (range, 9-43 cm3), which essentially replaced 40 6 13.7% (range, 26%-60%) of the absent temporal volume contributing to persistent temporal hollowing. CONCLUSION: Computer-designed, dual-purpose CCIs can be safely created with unprecedented shape to prevent and/or eradicate postoperative temporal deformity.
AB - BACKGROUND: The development of computer-assisted design, virtual modeling, and computed tomography has allowed precise customization of implants for patients who undergo neurosurgical or craniofacial surgery procedures. However, such techniques and implant designs have not adequately addressed temporal asymmetry due to postoperative bone resorption, temporalis muscle malposition/foreshortening, and/or temporal fat pad atrophy. OBJECTIVE: We hypothesized that an alteration in customized craniofacial implant (CCI) design with a strategic extension inferolaterally and excessive material bulking would provide simultaneous reconstruction of coexisting temporal skull defects and therefore reduce the effect of soft tissue deformities. METHODS: A single-surgeon, single-institution retrospective cohort study was performed to include 10 consecutive subjects who underwent cranioplasty reconstruction with modified implants during a 3-year period. Implants were placed with the use of our previously described pericranial-onlay technique. With the use of a computed tomography-based, computer-assisted design/manufacturing methodology, novel dual-purpose implants were designed to prevent and/or correct persistent temporal hollowing. The efficacy of the new CCI shape and design for cranial restoration of temporal symmetry was analyzed in both 2 and 3 dimensions. RESULTS: In 2-dimensional analyses, the modified implant provided enhanced lateral projection (21%; 1.06 cm) in areas closest to the temporal arch. Three-dimensional volumetric analyses demonstrated that additional bulking totaled 24 6 11 cm3 (range, 9-43 cm3), which essentially replaced 40 6 13.7% (range, 26%-60%) of the absent temporal volume contributing to persistent temporal hollowing. CONCLUSION: Computer-designed, dual-purpose CCIs can be safely created with unprecedented shape to prevent and/or eradicate postoperative temporal deformity.
KW - Computer-assisted design/manufacturing design
KW - Craniofacial reconstruction
KW - Cranioplasty
KW - Custom cranial implant
KW - Patient-specific craniofacial implant
KW - Persistent temporal hollowing
KW - Quantitative analysis
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U2 - 10.1227/NEU.0000000000000679
DO - 10.1227/NEU.0000000000000679
M3 - Article
C2 - 25710104
AN - SCOPUS:84944876622
SN - 2332-4252
VL - 11
SP - 220
EP - 229
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 2
ER -