Three-Dimensional Printed Polymethylmethacrylate Casting Molds for Posterior Fossa Reconstruction in the Surgical Treatment of Chiari I Malformation: Technical Note and Illustrative Cases

World Neurosurg. 2019 Sep:129:148-156. doi: 10.1016/j.wneu.2019.05.191. Epub 2019 May 29.

Abstract

Objective: To describe a new method for cranial reconstruction after posterior fossa craniectomy in the surgical treatment of Chiari 1 malformation through a technical note and presentation of 3 illustrative cases.

Methods and materials: A virtual surgical planning workflow was established for planning posterior fossa decompression, designing the suboccipital reconstruction, and manufacturing a 3D-printed polymethylmethacrylate (PMMA) casting mold. The casting accuracy was assessed by conducting a phantom experiment, and clinical data were provided by means of 3 illustrative cases.

Results: The accuracy of implant fabrication was found to be excellent, particularly when PMMA is introduced into the mold in a malleable state. In all 3 clinical cases, the implants were fabricated and positioned with success. Postoperative analysis revealed that accurate placement was achieved, with only minor deviation from the preoperative plan.

Conclusions: 3D virtual surgical planning provides feasible tools for the planning of posterior fossa decompression and intraoperative fabrication of accurate patient-specific suboccipital cranioplasty.

Keywords: 3D printing; 3D surgery; Chiari malformation type 1; Cranioplasty; Template; Virtual surgical planning.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Arnold-Chiari Malformation / surgery*
  • Cranial Fossa, Posterior / surgery
  • Craniotomy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Plastic Surgery Procedures / methods*
  • Polymethyl Methacrylate*
  • Printing, Three-Dimensional*
  • Prostheses and Implants*
  • Young Adult

Substances

  • Polymethyl Methacrylate