CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(02): 317-323
DOI: 10.1055/s-0042-1750812
Case Report

PMMA Cranioplasty Making by Using Оpen-Source CAD Software, PLA Printers, and Silicone Rubber Molds: Technical Note with Two Illustrative Cases

Azad Malikov
1   Department of Neurosurgery, Ankara City Hospital, Ankara, Turkey
Ahmet Eren Secen
1   Department of Neurosurgery, Ankara City Hospital, Ankara, Turkey
Ozgur Ocal
1   Department of Neurosurgery, Ankara City Hospital, Ankara, Turkey
Denizhan Divanlioglu
1   Department of Neurosurgery, Ankara City Hospital, Ankara, Turkey
› Author Affiliations


In this technical report, we discuss the design and production of polymethyl methacrylate (PMMA) implants, which we successfully applied in two patients using silicone molds, and a retrospective review of these patients at 1- and 6-month intervals. By using open-source computer-assisted design software, three-dimensional printers, and the patient's thin-sliced computed tomography data, we designed and produced the implant template and used it to make silicone rubber mоlds for intraoperative PMMA casting with good results. As a negative of the implant, we created a silicon mold, which can be autoclaved.

Two patients underwent PMMA cranioplasty using this method. Both implants were fitted into the defect without manipulation and good aesthetic аppеаrance of all patients was achieved. At follow-up 1 and 6 months after the operation, no complication was noted and the patients tolerated the cranioplasty platе wеll.

Publication History

Article published online:
24 August 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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  • References

  • 1 Feroze AH, Walmsley GG, Choudhri O, Lorenz HP, Grant GA, Edwards MS. Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends. J Neurosurg 2015; 123 (04) 1098-1107
  • 2 Munro IR, Guyuron B. Split-rib cranioplasty. Ann Plast Surg 1981; 7 (05) 341-346
  • 3 Viterbo F, Palhares A, Modenese E. Cranioplasty: the autograft option. J Craniofac Surg 1995; 6 (01) 80-83
  • 4 Harris DA, Fong AJ, Buchanan EP, Monson L, Khechoyan D, Lam S. History of synthetic materials in alloplastic cranioplasty. Neurosurg Focus 2014; 36 (04) E20
  • 5 Sanan A, Haines SJ. Repairing holes in the head: a history of cranioplasty. Neurosurgery 1997; 40 (03) 588-603
  • 6 Shah AM, Jung H, Skirboll S. Materials used in cranioplasty: a history and analysis. Neurosurg Focus 2014; 36 (04) E19
  • 7 Marbacher S, Andereggen L, Erhardt S. et al. Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty. Neurosurg Rev 2012; 35 (04) 527-535 , discussion 535
  • 8 Walker I, Vlok AJ, Kamat A. A double-edged sword: the effect of technological advancements in the management of neurotrauma patients. Br J Neurosurg 2017; 31 (01) 89-93
  • 9 Rengier F, Mehndiratta A, von Tengg-Kobligk H. et al. 3D printing based on imaging data: review of medical applications. Int J CARS 2010; 5 (04) 335-341
  • 10 Tan ET, Ling JM, Dinesh SK. The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer. J Neurosurg 2016; 124 (05) 1531-1537
  • 11 Baskaran V, Štrkalj G, Štrkalj M, Di Ieva A. Current applications and future perspectives of the use of 3D printing in anatomical training and neurosurgery. Front Neuroanat 2016; 10: 69
  • 12 Kwarcinski J. et al. Cranioplasty and craniofacial reconstructions: a review of implant material, manufacturing method, and infection risk. Applied Sciences 2017; 7 (03) 276
  • 13 Vaishya R, Chauhan M, Vaish A. Bone cement. J Clin Orthop Trauma 2013; 4 (04) 157-163
  • 14 Rotaru H, Baciut M, Stan H. , et al. . Silicone rubber mould cast polyethylmethacrylate-hydroxyapatite plate used for repairing skull defect. J Craniomaxillofac Surg 2006; 34 (04) 242-246
  • 15 Vlok AJ, Naidoo S, Kamat AS, Lamprecht D. Evaluation of locally manufactured patient-specific custom made implants for cranial defects using a silicone mould. S Afr J Surg 2018; 56 (03) 38-42
  • 16 Jamshidian M, Tehrany EA, Imran M, Jacquot M, Desobry S. Poly-lactic acid: production, applications, nanocomposites, and release studies. Compr Rev Food Sci Food Saf 2010; 9 (05) 552-571
  • 17 Lasprilla AJ, Martinez GA, Lunelli BH, Jardini AL, Filho RM. Poly-lactic acid synthesis for application in biomedical devices - a review. Biotechnol Adv 2012; 30 (01) 321-328
  • 18 Bartus C, William Hanke C, Daro-Kaftan E. A decade of experience with injectable poly-L-lactic acid: a focus on safety. Dermatol Surg 2013; 39 (05) 698-705
  • 19 Vleggaar D, Fitzgerald R, Lorenc ZP. Composition and mechanism of action of poly-L-lactic acid in soft tissue augmentation. J Drugs Dermatol 2014; 13 (4, Suppl): s29-s31