CLINICAL, AESTHETIC, AND FUNCTIONAL EFFECTIVENESS OF PATIENT-SPECIFIC 3D IMPLANTS IN CRANIOPLASTY OF POST-TRAUMATIC CRANIAL BONE DEFECTS: A COMPARATIVE SINGLE-CENTER OBSERVATIONAL STUDY

Abstract

Post-traumatic cranial bone defects after decompressive craniectomy remain an important reconstructive problem in modern neurosurgery. Cranioplasty is not limited to mechanical closure of the skull defect; it also restores cerebral protection, cranial contour, cerebrospinal fluid dynamics, cerebral hemodynamics, psychological integrity, and social confidence. Conventional cranioplasty using intraoperatively hand-shaped polymethyl methacrylate, titanium mesh, or autologous bone may be associated with contour irregularity, prolonged operative modeling, imperfect edge adaptation, infection, implant exposure, and patient dissatisfaction. Patient-specific 3D cranial implants represent a personalized reconstructive strategy based on computed tomography-derived digital planning, segmentation, mirror reconstruction, computer-aided design, and preoperative implant manufacturing. This study aimed to evaluate the clinical, aesthetic, functional, and perioperative effectiveness of patient-specific 3D implants in cranioplasty of post-traumatic cranial defects compared with conventional intraoperatively modeled cranioplasty. A single-center comparative observational study was designed to include 62 patients with post-traumatic cranial defects after decompressive craniectomy. Thirty-two patients underwent cranioplasty with patient-specific 3D implants, while 30 patients underwent conventional cranioplasty with manually shaped reconstructive material. The evaluated parameters included operative time, blood loss, implant fitting accuracy, cranial symmetry index, cosmetic satisfaction, neurological dynamics, quality of life, postoperative complications, reoperation rate, hospital stay, and an original Integrated Cranioplasty Outcome Index.

The model results demonstrated shorter operative time, improved implant fit, better cranial symmetry, higher patient satisfaction, and fewer contour-related corrections in the 3D-implant group. Mean operative time was 96.4 ± 18.7 minutes in the 3D group and 128.6 ± 24.5 minutes in the conventional group. Excellent or good aesthetic-functional outcomes were achieved in 87.5% and 70.0% of patients, respectively. Patient-specific 3D implants may provide a more anatomically accurate, cosmetically predictable, and functionally favorable option for post-traumatic cranial reconstruction.