Point-of-Care 3-Dimensional-Printed Polyetheretherketone Customized Implants for Cranioplastic Surgery of Large Skull Defects.

BACKGROUND AND OBJECTIVES: 3-Dimensional (3D) printing has become a common tool to aid implant molding for cranioplastic surgery of large skull defects. Until now, 3D printing of cranial implants itself has not been used, mainly because of medicolegal concerns. With a 3D printer developed for printing medical applications and with implant-grade polyetheretherketone (PEEK) filament available, we established a workflow (in compliance with medical device regulations) to 3D print cranial implants for cranioplastic surgery directly at the point of care (POC). Here, we describe the implementation of 3D printing these PEEK implants for cranioplastic surgery at our academic hospital. METHODS: A thorough design and 3D printing process, in accordance with local medical device regulations, was developed. Implants are digitally designed based upon pre- and post-craniectomy cranial computed tomography scans by trained 3D printing experts from the department of medical engineering at our institution. Implants are then produced on a medical 3D printer with implant-grade PEEK filament using the fused filament fabrication process. After postprocessing and steam sterilization, implantation for reconstruction of the skull can be performed. RESULTS: Cranioplastic surgery with a 3D-printed PEEK implant was performed at our institution in a patient with a large frontotemporoparietal skull defect after traumatic brain injury with consecutive decompressive craniectomy. No intra- or post-operative complications occurred. Postoperative cranial computed tomography scans showed perfect reconstruction of precraniectomy skull shape. The aesthetic result was promising and satisfactory to the patient. CONCLUSION: This novel 3D printing workflow enables the production of patient-specific cranial implants from PEEK, to reconstruct large skull defects directly at the POC in accordance with the European Medical Device Regulation. This marks an unprecedented technological and legal advancement, enabling the hospital infrastructure not only to deliver the cranioplastic surgery itself, but also additive manufacturing of the implant directly at the POC.

Intraoperative cone-beam computed tomography for catheter placement verification in pediatric hydrocephalus: technical note.

Ventriculoperitoneal (VP) shunt placement, essential for managing hydrocephalus, often risks catheter malpositioning, especially in patients with small ventricles. We present a novel technique combining neuronavigation with intraoperative cone-beam computed tomography using the BrainLab system and Loop-X mobile imaging unit. This approach enables real-time verification of catheter placement by integrating preoperative MRI data with intraoperative CT imaging. In a 12-year-old boy with therapy-refractory idiopathic intracranial hypertension, neuronavigation was guided by the BrainLab Skull Fix and Cushing canula, ensuring precise catheter insertion into the right frontal horn. Post-placement, Loop-X facilitated immediate verification of the catheter's trajectory and positioning, corroborated by postoperative MRI. This technique demonstrated high precision and minimized radiation exposure, emphasizing its utility in reducing revision rates due to suboptimal catheter placement.

The condylar capping for microvascular temporomandibular joint reconstruction: A preliminary study.

BACKGROUND: Defects of the temporomandibular joint (TMJ) are often difficult to be reconstructed in the correct dimensions and function. This preliminary study aims to describe a novel technique of condylar reconstruction with a microvascular flap in case of deforming arthrosis of the TMJ: condylar capping. PATIENTS AND METHODS: Four patients between 22 and 62 years old-three females and one male-with severe unilateral arthrosis of the TMJ underwent condylar capping. All patients had already had a failed conservative treatment, followed by arthroscopy with lysis and lavage and later open surgery with total or subtotal diskectomy combined with a condylar arthroplasty. Nevertheless, their pain was still at level six or more on a visual analogue scale. Moreover, they could eat only soft food. At this stage, they underwent condylar capping using an osteochondral lateral femoral condyle (LFC) flap. The surgical technique and the postoperative management are described in detail. Crucially the attachment of the lateral pterygoid muscle to the condylar neck was preserved in all cases. The patients were followed up clinically and by CT scan preoperatively, 6, and 12 months postoperatively. RESULTS: The mean height of the reconstructed neo-condyle was 6.0 mm, the mean width 16.2 mm, and the mean sagittal length 9.8 mm. The follow-up period ranged from 14 to 64 months. The procedures were uneventful for all patients, and the donor site morbidity was negligible. Twelve months later, the patients were all pain-free and able to have a regular diet. The TMJ and the knee had a normal range of movement and power. Postoperative imaging demonstrated bone healing and stable and anatomically correct condyle reconstruction. CONCLUSIONS: Based on the author's experience, the condylar capping with the LFC appears promising for reconstructing the condylar head in cases of severe osteoarthritis. Preserving the attachment of the lateral pterygoid muscle allows a complete restoration of the physiologic range of movement, including protrusion and laterotrusion of the mandible.

[New Technologies in Microsurgery: Potential, Indications and Economical Aspects - Report of the Consensus Workshop of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels (DAM)]. / Neue Technologien in der Mikrochirurgie: Potential, Indikationen und ökonomische Aspekte ­ Konsensus-Bericht der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM).

Recently, several new technologies to support microsurgeons have received European market approval. This article summarizes and discusses the impressions of an expert panel to classify the potential of new technologies in terms of benefits for the surgeon, specific indications and economic aspects during the 42nd Annual Meeting of the German-speaking Working Group for Microsurgery of Peripheral Nerves and Vessels (DAM) in Graz, Austria. In general, the expert panel addressed the principles and prerequisite for the successful establishment of new technologies and, in particular, novel optical and robotic systems. For this purpose, the current scientific literature was reviewed and initial clinical experience in the context of case series and retrospective studies was presented by the members of the expert panel. In the ensuing discussion, it was pointed out that it will first be necessary to identify patient subgroups in which the use of the new technologies is most likely to achieve a clinical benefit. Since clinical approval has already been granted for some systems, an approach can be developed for immediate clinical application from the simplest possible use to ever finer applications, i. e. from microsurgery to supermicrosurgery. Initially, funding for cost-intensive systems would presumably not be possible through revenue from standard care, but only through grants or subsidized clinical trials. In a final survey, the majority of meeting participants see the need for a price reduction of both visualization and surgical robotics technologies to enable widespread clinical establishment. Likewise, a majority of participants would prefer a combination of an exoscope or robotic microscope and a surgical robot for clinical use. The present consensus work addresses the development of a strategy for the effective establishment of new technologies, which should further increase the surgical quality of selected interventions.

The role of the titanium functionally dynamic bridging plate for the treatment of the atrophic mandible fractures.

The role of the titanium functionally dynamic bridging plate (TFDBP) in the fracture treatment of the severely atrophic mandible was assessed retrospectively. In 28 consecutive patients with fractures of a severely atrophic mandible fixation was carried out with TFDBPs. Twenty-one patients with 27 fractures were included in the study and then followed up for complications and the progress of fracture healing for 17 months postoperatively on average. There was only one case that required plate removal. All patients showed bone healing 3 months after surgery. The mental nerve sensation improved in 12 out of 23 fractures that had presented with nerve function disturbance. Every patient who had dentures prior to sustaining the fracture was able to return to denture wearing 3 weeks after surgery. No major complications occurred. A high proportion of bone healing with a low complication rate was observed with the use of TFDBPs in the treatment of severely atrophic mandible fractures. The TFDBP is an excellent alternative to conventional plating of the severely atrophic mandible.