Three-Dimensional Printed Polymethylmethacrylate Casting Molds for Posterior Fossa Reconstruction in the Surgical Treatment of Chiari I Malformation: Technical Note and Illustrative Cases.

Abstract

To describe a new method for cranial reconstruction after posterior fossa craniectomy in the surgical treatment of Chiari 1 malformation through a technical note and presentation of 3 illustrative cases. A virtual surgical planning workflow was established for planning posterior fossa decompression, designing the suboccipital reconstruction, and manufacturing a 3D-printed polymethylmethacrylate (PMMA) casting mold. The casting accuracy was assessed by conducting a phantom experiment, and clinical data were provided by means of 3 illustrative cases. The accuracy of implant fabrication was found to be excellent, particularly when PMMA is introduced into the mold in a malleable state. In all 3 clinical cases, the implants were fabricated and positioned with success. Postoperative analysis revealed that accurate placement was achieved, with only minor deviation from the preoperative plan. 3D virtual surgical planning provides feasible tools for the planning of posterior fossa decompression and intraoperative fabrication of accurate patient-specific suboccipital cranioplasty.