Considerations in computer-aided design for inlay cranioplasty: technical note

CONTEXT: Cranioplasty is a frequently performed procedure that uses a variety of reconstruction materials and techniques. In this technical note, we present refinements of computer-aided design–computer-aided manufacturing inlay cranioplasty. OBJECTIVE, DESIGN, AND SETTING: In an attempt to decrease complications related to polyether-ether-ketone (PEEK) cranioplasty, we gradually made changes to implant design and cranioplasty techniques. These changes include under-contouring of the implant and the use of segmented plates for large defects, microplate fixation for small temporal defects, temporal shell implants to reconstruct the temporalis muscle, and perforations to facilitate the drainage of blood and cerebrospinal fluid and serve as fixation points. RESULTS: From June 2016 to June 2017, 18 patients underwent cranioplasty, and a total of 31 PEEK and titanium implants were inserted. All implants were successful. CONCLUSIONS: These changes to implant design and cranioplasty techniques facilitate the insertion and fixation of patient-specific cranial implants and improve esthetic outcomes.