DIGITAL PLANNING AND ECONOMIC EFFECTIVENESS OF CRANIOPLASTY USING PATIENT-SPECIFIC 3D IMPLANTS FOR LARGE CRANIAL DEFECTS

Abstract

Large cranial defects after decompressive craniectomy, traumatic brain injury, ischemic stroke, intracranial hemorrhage, infection, or tumor surgery represent a complex reconstructive challenge requiring precise anatomical restoration, reliable cerebral protection, satisfactory cosmetic contour, and economically rational surgical planning. Conventional cranioplasty with intraoperatively molded polymethyl methacrylate, manually shaped titanium mesh, or preserved autologous bone may be limited by prolonged operative modeling, imperfect marginal adaptation, contour asymmetry, increased soft-tissue manipulation, implant instability, and the need for secondary correction. Digital cranioplasty planning based on computed tomography, DICOM processing, segmentation, mirror reconstruction, computer-aided implant design, STL modeling, additive manufacturing, sterilization, implantation, and postoperative CT-based accuracy assessment has introduced a patient-specific reconstructive paradigm. This study aimed to develop and evaluate a standardized digital planning algorithm for cranioplasty with patient-specific 3D implants in large cranial defects and to compare its clinical, radiological, aesthetic, and economic effectiveness with conventional intraoperative implant modeling. A single-center comparative observational study was designed to include 48 patients with large cranial defects exceeding 50 cm². Twenty-five patients underwent digitally planned cranioplasty with patient-specific 3D implants, while 23 patients underwent conventional cranioplasty with intraoperatively shaped reconstructive materials. Outcomes included operative time, implant fixation time, blood loss, postoperative CT-based fit accuracy, cranial symmetry, hospital stay, complication rate, patient satisfaction, direct treatment cost, and an original Implant Fit Accuracy Score. The patient-specific 3D implant group demonstrated shorter operative time, superior implant fit, improved cranial symmetry, lower need for intraoperative remodeling, fewer contour-related corrections, and higher patient satisfaction. Although preoperative implant production increased initial material cost, total cost analysis suggested partial compensation through reduced operative duration, shorter hospitalization, and fewer reoperations. Digital planning may therefore represent an anatomically accurate and economically justified strategy for selected patients with large or complex cranial defects.