On-Demand Intraoperative 3-Dimensional Printing of Custom Cranioplastic Prostheses

BACKGROUND

Currently, implantation of patient-specific cranial prostheses requires reoperation after a period for design and formulation by a third-party manufacturer. Recently, 3-dimensional (3D) printing via fused deposition modeling has demonstrated increased ease of use, rapid production time, and significantly reduced costs, enabling expanded potential for surgical application. Three-dimensional printing may allow neurosurgeons to remove bone, perform a rapid intraoperative scan of the opening, and 3D print custom cranioplastic prostheses during the remainder of the procedure.

OBJECTIVE

To evaluate the feasibility of using a commercially available 3D printer to develop and produce on-demand intraoperative patient-specific cranioplastic prostheses in real time and assess the associated costs, fabrication time, and technical difficulty.

METHODS

Five different craniectomies were each fashioned on 3 cadaveric specimens (6 sides) to sample regions with varying topography, size, thickness, curvature, and complexity. Computed tomography-based cranioplastic implants were designed, formulated, and implanted. Accuracy of development and fabrication, as well as implantation ability and fit, integration with exiting fixation devices, and incorporation of integrated seamless fixation plates were qualitatively evaluated.

RESULTS

All cranioprostheses were successfully designed and printed. Average time for design, from importation of scan data to initiation of printing, was 14.6 min and average print time for all cranioprostheses was 108.6 min.

CONCLUSION

On-demand 3D printing of cranial prostheses is a simple, feasible, inexpensive, and rapid solution that may help improve cosmetic outcomes; significantly reduce production time and cost-expanding availability; eliminate the need for reoperation in select cases, reducing morbidity; and has the potential to decrease perioperative complications including infection and resorption.

Comparison between killed and living probiotic usage versus placebo for the prevention of necrotizing enterocolitis and sepsis in neonates

The aim of the study is to compare the role of killed (KP) Lactobacillus acidophilus with living (LP) in reducing incidence of sepsis (NS) and necrotizing enterocolitis (NEC) in neonates. Randomized double blind placebo study, included 150 neonates admitted to NICU at day 1, sixty received oral (LP) and 60 received (KP) and 30 received placebo. One gram of stools was collected on admission, at day 7, at end of the study, as well as on suspected NEC or NS and was sent for culture.

RESULTS

LP and KP were preventive factors for NEC with absolute risk reduction (AAR) 16, 15%, respectively and 18% for NS compared to placebo. Incidence of NEC and NS did not differ significantly between neonates supplemented with LP and those with KP. Preterm neonates supplemented with KP showed significantly lower incidence of NEC compared to placebo, while incidence of NS showed no significant difference between both groups. There is significant reduction in NS and NEC among neonates with positive Lactobacillus colonization of gut compared to those none colonized at day 7 (27.9 vs. 85.9%, 0 vs. 7.8%) and at day 14 (48.7 vs. 91.7% for NS and 0 vs. 20.8% for NEC). Overall comparison between the three groups showed statistical significant reduction in the incidence of NEC. Present conclusions are that early gut colonization with beneficial bacteria lowers the incidence of NEC and NS. KP retained similar benefits to live bacteria.

Cord blood brain derived neurotrophic factor: diagnostic and prognostic marker in fullterm newborns with perinatal asphyxia

This prospective case control study was designed to evaluate cord blood brain derived neurotrophic factor level in full term newborns with perinatal asphyxia as a marker of central nervous system insult and predictor of severity of hypoxic ischemic encephalopathy, with follow up of its level during the reperfusion phase. The study included twenty fullterm neonates with perinatal asphyxia (cases) and twenty controls. Cord blood samples were obtained at birth and peripheral blood samples at 72 h postnatal from cases only. Plasma brain derived neurotrophic factor level was measured using enzyme linked immunosorbent assay. The clinical severity of encephalopathy was graded based on Sarnat and Sarnat staging. Cord Plasma brain derived neurotrophic factor level was significantly increased among cases compared to controls. Among cases, brain derived neurotrophic factor level at delivery and after 72 h significantly correlated with the severity of encephalopathy according to Sarnat staging being higher as severity increases. Brain derived neurotrophic factor level significantly increased after 72 h of life compared to its level at delivery among cases. Brain derived neurotrophic factor levels at delivery and at 72 h postnatal were predictors of severe Sarnat stage and poor outcome. We concluded that brain derived neurotrophic factor level as a marker of central nervous system insult is increased in full term newborns with perinatal asphyxia. It can serve as an indicator for the severity of encephalopathy and adverse outcomes.