Case Report

Cranioplasty with preoperatively customized Polymethyl-methacrylate by using 3-Dimensional Printed Polyethylene Terephthalate Glycol Mold

Mehmet Beşir Sürme*, Omer Batu Hergunsel, Bekir Akgun and Metin Kaplan

Published: 30 November, 2018 | Volume 2 - Issue 2 | Pages: 052-064

Cranioplasty is a reconstructive procedure for the repair of skull defects or deformities. Polymethyl-methacrylate (PMMA) is a commonly used alloplastic material when autologous bone is unavailable. However, manual shaping of bone cement for frontal and orbital bone defects is challenging and may not lead to cosmetically satisfactory results. Advances in computer-aided 3-dimensional (3D) design and printing technology allow the production of patient-customized implants with improved cosmetic and functional results. A 39-year-old female patient presented with right-sided frontal swelling and headache. Computerized tomography (CT) demonstrated a right frontal calvarial mass extending to the orbital wall. The boundaries of the lesion were marked using a 3D design software. A polyethylene terephthalate glycol (PETG) mold was manufactured with help of a 3D printer. Artificial bone flap was formed by pouring PMMA into the mold. After surgical resection of the calvarial mass, customized PMMA implant was applied with titanium mini plate and screws. The defect was closed properly with good aesthetic results. Production of customized PMMA cranioplasty implants with 3D printed molds is a useful technique and can be preferred for calvarial defects due to skull tumors, bone resorption and traumatic bone loss.

Read Full Article HTML DOI: 10.29328/journal.jnnd.1001016 Cite this Article Read Full Article PDF


Cranioplasty; Polymethyl-methacrylate; 3-Dimensional modelling


  1. Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, et al. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg. 2006; 104: 469–479. Ref.: https://goo.gl/U2LxpY
  2. Park EK, Lim JY, Yun IS, Kim JS, Woo SH, et al. Cranioplasty Enhanced by Three-Dimensional Printing: Custom-Made Three-Dimensional-Printed Titanium Implants for Skull Defects. J Craniofac Surg. 2016; 27: 943–949. Ref.: https://goo.gl/AcWSNu
  3. Kim JC, Hong IP. Split-rib cranioplasty using a patient-specific three-dimensional printing model. Arch Plast Surg 2016; 43: 379–381. Ref.: https://goo.gl/3TsAKv
  4. Kim BJ, Hong KS, Park KJ, Park DH, Chung YG, et al. Customized cranioplasty implants using three-dimensional printers and polymethyl-methacrylate casting. J Korean Neurosurg Soc. 2012; 52: 541–546. Ref.: https://goo.gl/4G8T8Z
  5. Aydin S, Kucukyuruk B, Abuzayed B, Aydin S. Sanus GZ. Cranioplasty: Review of materials and techniques. J Neurosci Rural Pract. 2011; 2: 162–167. Ref.: https://goo.gl/o3MGh7
  6. Golz T, Graham CR, Busch LC, Wulf J, Winder RJ. Temperature elevation during simulated polymethylmethacrylate (PMMA) cranioplasty in a cadaver model. J Clin Neurosci. 2010; 17: 617–622. Ref.: https://goo.gl/tBNxg3
  7. Iwama T, Yamada J, Imai S, Shinoda J, Funakoshi T, et al. The use of frozen autogenous bone flaps in delayed cranioplasty revisited. Neurosurgery. 2003; 52: 591-596. Ref.: https://goo.gl/B1LDYp
  8. De La Peña A, De La Peña-Brambila J, Pérez-De La Torre J, Ochoa M, Guillermo J. Gallardo, Low-cost customized cranioplasty using a 3D digital printing model: a case report. 3D Print Med. 2018; 4: 4. Ref.: https://goo.gl/eJwpRZ
  9. Pikis S, Goldstein J, Spektor S. Potential neurotoxic effects of polymethylmethacrylate during cranioplasty. J Clin Neurosci. 2015; 22: 139-143. Ref.: https://goo.gl/sia4LV
  10. Parthasarathy J. 3D modeling, custom implants and its future perspectives in craniofacial surgery. Ann Maxillofac Surg. 2014; 4: 9-18. Ref.: https://goo.gl/yECgLD
  11. Tan ET, Ling JM, Dinesh SK. The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer. J Neurosurg. 2016; 124: 1531–1537. Ref.: https://goo.gl/RSLCgg
  12. Seitz, H, Marlovits S, Schwendenwein I, Müller E, Vécsei V. Biocompatibility of polyethylene terephthalate (Trevira® hochfest) augmentation device in repair of the anterior cruciate ligament. Biomaterials. 1998; 19: 189–196. Ref.: https://goo.gl/wSRJ9o
  13. Hatamleh MM, Cartmill M, Watson J. Management of Extensive Frontal Cranioplasty Defects. J Craniofac Surg 2013; 24: 2018–2022. Ref.: https://goo.gl/DGKFKz


Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?