Clinical Outcomes of Cranioplasty Using a Customized Artificial Bone Flap Made by a 3D Printing Technique

Cranioplasty is required to restore the appearance of the skull, Objective To analyze the outcomes of using a customized artificial skull bone flap made with a three-dimensional (3D) printing technique for cranioplasty and compare them with those of the autobone technique. Method Between December 2018 and February 2020, 24 cranioplasties were performed for 24 hemispheres using a customized artificial bone flap made by 3D printing. Simultaneously, 19 cranioplasties for 19 hemispheres were performed using an autobone. Three patients underwent cranioplasty using both a customized artificial bone flap and autobone for each hemisphere. Patient’s demographics, reason for craniectomy, interval between craniectomy and cranioplasty, surface area of the skull defect and bone flap, bone flap coverage of the defect, cranioplasty-related factors, and clinical outcome were assessed. Results Forty patients who underwent cranioplasty (bone flap, 21; autobone flap, 16; and artificial bone/ autobone flaps, 3) were enrolled. The artificial bone flap covered more skull defects than the autobone flap (98.6% vs. 90.9%, p=0.000). There were two and six operation-related complications in the artificial bone flap and autobone flap groups, respectively (P=0.061). The subtemporal area was completely covered in the artificial bone flap group. Two patients had an infection of the autobone flap and had it replaced by a 3D printing flap. No patient showed a reduction in the modified Rankin Scale score after surgery, and the clinical course was confirmed to have improved. Conclusions Cranioplasty using customized artificial bone flap made by 3D printing technique was effective for covering the skull defect and tends to have a low complication rate compared to the autobone.