Cranioplasty with patient-specific implants in repeatedly reconstructed cases

Objective: Cranioplasty is indicated to restore form and function of bone defects of the neurocranium. Autografts are the gold standard, alloplastic materials are used when autologous bone is unavailable or unsuitable, and increasing evidence supports the use of patient-specific implants (PSIs) for reconstruction. We reviewed our own patient data to assess pre- and intraoperative aspects, complications and costs in patients that were treated with PSIs from titanium or polyetheretherketone (PEEK) for skull bone reconstruction. Methods: We retrospectively evaluated all patients receiving a PSI as at least a secondary reconstruction between 2004 and 2016 at Maastricht University Medical Center. These cases were analyzed for demographics, perioperative surgical and medical aspects, as well as costs. Results: In total 30 patients received PSIs, of which 20 were included in this study. Duration of PSI placement was not statistically different between group I, where previously placed reconstruction material was still in situ, and group II, where no remaining previously placed reconstruction material was present (group I: 104 ± 27 mins, group II: 86 ± 36 mins; p = 0.27). Postoperatively, 2 patients experienced complications (10%). Costs of obtaining the PSIs were not significantly different between group I and group II (group I: mean EUR 7536 ± 2759, group II: mean EUR 8351 ± 2087, p = 0.51). Conclusion: Treatment of skull bone defects in repeated reconstruction requires an optimal preoperative planning and intraoperative procedure. In this retrospective study comparing repeatedly reconstructed cases with and without remaining previously placed reconstruction material present at the surgical site, we could not find significant differences in the duration of the surgical procedure nor costs of obtaining the PSIs. The protocol followed at MUMC for preoperative planning, manufacturing, and surgery, represents the current state-of-the-art treatment.