Background: Cranial reconstruction is a common
consequence of neurosurgical disease and intervention following craniectomy,
trauma, infection, congenital defects, or neoplasm. Most commonly, Computer
Aided Design-Computer Aided Manufacturing (CAD-CAM) technology is utilized
in cases where autologous bone cannot be used. These patient-specific
implants provide excellent cosmesis, however individual costs range from
$800-15,000, making routine use challenging in the current Canadian health
care environment. Here we present a novel method using desktop 3D printers
to manufacture patient-specific molds for intraoperative reconstruction of
various cranial defects. Methods: Our first patient
presented following two separate traumas requiring decompressive craniectomy
and subsequent posterior fossa decompression without interval cranioplasty.
The second patient required reconstruction during resection of intraosseous
meningioma. Both cases were performed using a
titanium-mesh/poly-methyl-methacrylate (Ti-PMMA) construct draped over the
mold. The third case, cranioplasty following decompressive craniectomy
outside the country, was performed using a “two piece” mold and PMMA was
casted into the mold and allowed to harden. Results:
Patients reported satisfaction with cosmesis, without adverse outcomes. Cost
per case was $50-100, representing an estimated cost savings of $685,000 per
year in Canada. Conclusions: Given excellent outcomes
in addition to cost effectiveness, this case series provides evidence for
use of this alternate technique with similar patient outcomes.