Low-Cost 3-D-Printer-Assisted Personalized Cranioplasty Treatment: A Case Series of 14 Consecutive Patients.

OBJECTIVE: The current study used polylactic acid molds [developed locally using three-dimensional printers and our software] and polymethyl methacrylate (PMMA) to perform cranioplasty of bone defects in technically demanding areas of the skull while ensuring ideal cosmetic results and functional recovery. The overall aim was to identify the ideal method for standard cranioplasty procedures METHODS: Polylactic acid duplicates of the skull defects were created for eligible patients, after which a two-part negative mold composed of plaster and silicone was used to form artificial bone with PMMA. Thereafter, cranioplasty was performed and the treatment success was assessed by evaluating the percentage of similarity objectively and the body image scale subjectively. RESULTS: No surgical complications were seen to occur in the 14 patients included in the current study. Furthermore, the subjective and objective evaluation revealed a significant improvement in outcomes (p < 0.05). No postoperative complications were observed over a follow-up period of 6 months, except in 1 patient who exhibited late infection. CONCLUSIONS: Cranioplasty operations were performed at an economical price of approximately US$50 dollars, suggesting that this method can be applied widely. Furthermore, preoperative preparation of the PMMA models can help reduce the duration of anesthesia and surgery which, in turn, will minimize the risk of surgical complications. Based on current knowledge in the field, we believe that this method represents the ideal technique.

Shunt Fractures Associated with Intermittent Hydrocephalus: Case Reviews and New Solutions.

OBJECTIVE: Although ventriculoperitoneal shunt surgery is the most common method for hydrocephalus treatment, it may lead to serious complications and require surgical interventions. Peritoneal catheter fracture is one of the common complications that may cause intermittent hydrocephalus. If patients with peritoneal catheter fracture have symptoms of hydrocephalus and ventricular dilatation, the treatment algorithm is clear. However, the diagnosis and treatment protocol remains unclear otherwise. In this article, the possible mechanisms of hydrocephalic symptoms, the diagnosis, as well as treatment algorithms are examined. METHODS: Eight patients with a ventriculoperitoneal shunt who had intermittent hydrocephalic symptoms due to peritoneal catheter fracture but without any radiologically significant ventricular dilatation at Nigde Ömer Halisdemir University from 2018 to 2021 were collected. A new diagnostic algorithm was created. Patient follow-up was performed in each patient as a procedure. RESULTS: The method that we determined was successful in all our patients. No complications were observed. We have followed the patients with a normal clinic for at least 6 months. CONCLUSIONS: The provocation test we have formulated always revealed the true cause of the clinic. Thus, on the one hand, with a positive provocation test we recommend revision surgery without waiting for the ventricular dilatation or hydrocephalic symptoms in patients with a fractured peritoneal catheter, considering the results of asymptomatic shunt revision surgery have been reported to be better than those with symptomatic shunt dysfunction; on the other hand, patients with negative provocation tests are saved from unnecessary surgical intervention as well as benefit from true etiologic fast treatment.

The association of Chiari type III malformation and Klippel-Feil syndrome with mirror movement: a case report.

Basically Chiari type III malformation is a combination of encephalocele with of brain stem and cerebellar abnormality. Although Klippel-Feil syndrome may be associated with other congenital anomalies, this syndrome is mainly associated with varying degrees of cervical vertebral fusion anomalies. In this study, we reported the association of Chiari type III malformation and Klippel-Feil syndrome with the mirror movement by imaging studies. The main involvement in Chiari type III malformation and Klippel-Feil syndrome is in the craniocervical junction. In such a small area, the emergence of these complex pathologies in our case was remarkable. Our patient had reconstruction surgery of the posterior fossa and his encephalocele was excised successfully. Hydrocephaly and/or deterioration in the functions of other posterior fossa structures have not been seen in the patient's follow-up.