Mr. Desai, a 41-year-old male, met with a road accident that resulted in a traumatic brain injury and was promptly taken to Apollo Hospitals, Navi Mumbai on September 15, 2018. When bought in, he was unconscious, with evident CSF rhinorrhoea and otorrhoea from left ear, and herniating brain tissue from the left nostril.
Once the patient was stabilized, he was taken for an urgent Craniotomy for evacuation of subdural Hematoma, intra-cerebral contusion, and repairing of the skull base. He was then moved to the ICU for recovery, which in view of the severe brain injury was slow. On October 29, 2018, he was finally discharged as his sensorium had improved.
The patient’s brain was allowed to heal for several months before the planned Cranioplasty. The team of doctors at Apollo Hospitals, Navi Mumbai, had to ensure the best possible cosmesis without major intraoperative manipulation of the skull base repair. The defect also covered a large part of the forehead extending to the bridge of the nose and the left supraorbital ridge – all of which had cosmetic implications. Hence, 3D-printed titanium implant was opted because it would closely replicate the shape of the patient’s skull. On January 9, 2019, the patient underwent Cranioplasty with the implant, after which he made a swift recovery and was discharged three days later.
3D-printed implants are beneficial for multiple reasons like it fits the patient’s form, MRI compatible and lesser chances of getting infection. In this case, first a CT scan helped make an identical 3D model of the skull in its current form. Then a titanium mesh was created to perfectly fit the skull. Once it was ensured that the implant was a perfect match for the patients’ structure, the neurosurgeons went ahead with the Cranioplasty.
Dr Sunil Kutty, Consultant, Neurosurgery, Apollo Hospitals, Navi Mumbai said, “It was a bad case of head injury and not many survive these kinds of injuries. His recovery was a team effort and we also had a challenge in the form of making his face and head look as normal as possible. After being admitted on September 15, 2018, Mr. Desai was in the hospital for about a month and half, before being discharged. After allowing the brain of patient to heal for several months, Cranioplasty (surgical repair of a defect or deformity of a skull) was undertaken. The team needed to ensure the best possible cosmesis without major manipulation of the skull base. A large part of the forehead extending to the bridge of the nose and part of the ridge was affected and had cosmetic implications. Therefore, we decided that a 3D printed titanium implant would be suitable to closely replicate the shape of the patient’s skull. On January 9, 2019, the patient was bought in for the Cranioplasty with the implant and was discharged three days later. 3D printed implants are MRI compatible, decrease the risk of infections and most importantly can be made to fit the patient’s form. Mr. Desai may take a couple of years for complete recovery, but he will soon get back to being a constructive part of the society.”