No CrossRef data available.
Article contents
The Impact of Low-Cost Customized Cranioplasty Implants in a Low-Income Population: Does Quality of Life Improve?
Published online by Cambridge University Press: 11 April 2025
Abstract
Background:
Individuals undergoing cranioplasty may encounter persistent functional impairments. Quality-of-life (QoL) assessment to address this is essential. This study aims to evaluate the long-term improvement in QoL after a cranioplasty at our center.
Methods:
In this observational, retrospective study, we assessed the QoL of patients who underwent cranioplasty and could be contacted by our research team. QoL was evaluated using EuroQol-5D-3L and SF-36 scales through phone interviews. We evaluated QoL changes at 3, 6 and 12 months. Friedman’s test and repeated measures ANOVA were used to assess QoL improvement through time. An exploratory analysis to search for possible modifiers of QoL improvement was conducted.
Results:
We included 28 patients with a median age of 30 (IQR 20−52) years, of whom 19 (79.2%) had a history of trauma. Twenty (71.4%) patients underwent cranioplasty with custom-made 3D-modeled implants. Long-term improvements in general QoL were observed in mobility, self-care, usual activities and pain/discomfort (p < 0.001). Improvement in SF-36 scores showed significant mean differences in role limitations due to physical health (−32.14, 95% CI −50.37 to −13.91; p < 0.001), role limitations due to emotional problems (−21.43, 95% CI −38.5 to −4.35; p = 0.010) and pain (−9.65, 95% CI −16.36 to −2.93; p = 0.003). There were no significant modifiers of QoL improvement.
Conclusion:
This study showed promising results about QoL improvement experienced by patients with low-cost customized implants. Further research is necessary to preserve clinical and self-reported improvement and conduct patient-centered neurosurgical care.
Résumé
L’impact des implants de cranioplastie personnalisés à faible coût sur une population à faibles revenus : est-ce que leur qualité de vie s’améliore ?
Les personnes subissant une cranioplastie peuvent souffrir de troubles fonctionnels persistants. Il est donc essentiel d’évaluer leur qualité de vie pour y remédier. Cette étude vise donc à évaluer l’amélioration à long terme de la qualité de vie des patients après une cranioplastie effectuée dans notre établissement.
Dans cette étude observationnelle rétrospective, nous avons évalué la qualité de vie des patients ayant subi une cranioplastie et pouvant être contactés par notre équipe de recherche. La qualité de vie a été évaluée à l’aide des instruments EQ-5D-3L et SF-36 lors d’entretiens téléphoniques. Nous avons évalué les changements de qualité de vie au bout de 3, 6 et 12 mois. Le test de Friedman et l’ANOVA à mesures répétées ont été utilisés pour évaluer l’amélioration de la qualité de vie au fil du temps. Une analyse exploratoire a aussi été réalisée afin de rechercher d’éventuels modificateurs de l’amélioration de la qualité de vie.
Nous avons inclus 28 patients dont l’âge médian était de 30 ans (EI 20-52). De ce nombre, 19 d’entre eux (79,2 %) avaient des antécédents de traumatisme. Notons que 20 patients (71,4 %) ont subi une cranioplastie avec des implants sur mesure modélisés en 3D. Des améliorations à long terme de leur qualité de vie générale ont été observées en termes de mobilité, d’autonomie, d’activités habituelles et de douleur/inconfort (p < 0,001). L’amélioration des scores au SF-36 a montré des différences moyennes significatives en ce qui concerne les limitations fonctionnelles attribuables à la santé physique (-32,14; IC 95 % : -50,37 à -13,91; p < 0,001), à des problèmes émotionnels (-21,43; IC 95 % : -38,5 à -4,35; p = 0,010) et à la douleur (-9,65; IC 95 % : -16,36 à -2,93; p = 0,003). Enfin, aucun facteur modificateur significatif de l’amélioration de la qualité de vie n’a été observé.
Cette étude a montré des résultats prometteurs en ce qui regarde l’amélioration de la qualité de vie des patients ayant bénéficié d’implants personnalisés à faible coût. Des recherches supplémentaires sont ainsi nécessaires pour maintenir l’amélioration clinique et auto-déclarée et mettre en place des soins neurochirurgicaux centrés sur les patients.
Information
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation
References
Czyżewski, W, Jachimczyk, J, Hoffman, Z, et al. Low-cost cranioplasty—A systematic review of 3D printing in medicine. Materials. 2022;15:4731. DOI: 10.3390/ma15144731.10.3390/ma15144731CrossRefGoogle ScholarPubMed
Zegers, T, Ter Laak-Poort, M, Koper, D, Lethaus, B, Kessler, P. The therapeutic effect of patient-specific implants in cranioplasty. J Cranio-Maxillofac Surg. 2017;45:82–6. DOI: 10.1016/j.jcms.2016.10.016.10.1016/j.jcms.2016.10.016CrossRefGoogle ScholarPubMed
Wehmöller, M, Weihe, S, Rasche, C, Scherer, P, Eufinger, H. CAD/CAM-prefabricated titanium implants for large skull defects—clinical experience with 166 patients from 1994 to 2000. Int Congr Ser. 2004;1268:667–72. DOI: 10.1016/j.ics.2004.03.112.10.1016/j.ics.2004.03.112CrossRefGoogle Scholar
De Cola, MC, Corallo, F, Pria, D, Lo Buono, V, Calabrò, RS. Timing for cranioplasty to improve neurological outcome: a systematic review. Brain Behav. 2018;8:e01106. DOI: 10.1002/brb3.1106.10.1002/brb3.1106CrossRefGoogle ScholarPubMed
Shahid, AH, Mohanty, M, Singla, N, Mittal, BR, Gupta, SK. The effect of cranioplasty following decompressive craniectomy on cerebral blood perfusion, neurological, and cognitive outcome. J Neurosurg. 2018;128:229–35. DOI: 10.3171/2016.10.JNS16678.10.3171/2016.10.JNS16678CrossRefGoogle ScholarPubMed
Paredes, I, Castaño-León, AM, Munarriz, PM, et al. Cranioplasty after decompressive craniectomy. A prospective series analyzing complications and clinical improvement. Neurocirugia. 2015;26:115–25. DOI: 10.1016/j.neucir.2014.10.001.10.1016/j.neucir.2014.10.001CrossRefGoogle ScholarPubMed
Aloraidi, A, Alkhaibary, A, Alharbi, A, et al. Effect of cranioplasty timing on the functional neurological outcome and postoperative complications. Surg Neurol Int. 2021;12:264. DOI: 10.25259/SNI_802_2020.10.25259/SNI_802_2020CrossRefGoogle ScholarPubMed
Singh, S, Singh, R, Jain, K, Walia, B. Cranioplasty following decompressive craniectomy – analysis of complication rates and neurological outcomes: a single center study. Surg Neurol Int. 2019;10:142. DOI: 10.25259/SNI_29_2019.10.25259/SNI_29_2019CrossRefGoogle ScholarPubMed
Giese, H, Antritter, J, Unterberg, A, Beynon, C. Long-term results of neurological outcome, quality of life, and cosmetic outcome after cranioplastic surgery: a single center study of 202 Patients. Front Neurol. 2021;12:702339. DOI: 10.3389/fneur.2021.702339.10.3389/fneur.2021.702339CrossRefGoogle ScholarPubMed
Worm, PV, Finger, G, Ludwig do Nascimento, T, Rynkowski, CB, Collares, MVM. The impact of cranioplasty on the patients’ quality of life. J Cranio-Maxillofac Surg. 2019;47:715–9. DOI: 10.1016/j.jcms.2019.01.040.10.1016/j.jcms.2019.01.040CrossRefGoogle ScholarPubMed
LIVSFORSK network, Haraldstad, K, Wahl, A et al. A systematic review of quality of life research in medicine and health sciences. Qual Life Res. 2019;28:2641–50. DOI: 10.1007/s11136-019-02214-9.CrossRefGoogle ScholarPubMed
Mar, J, Arrospide, A, Begiristain, JM, Larrañaga, I, Elosegui, E, Oliva-Moreno, J. The impact of acquired brain damage in terms of epidemiology, economics and loss in quality of life. BMC Neurol. 2011;11:46. DOI: 10.1186/1471-2377-11-46.10.1186/1471-2377-11-46CrossRefGoogle ScholarPubMed
Baumann, M, Le Bihan, E, Chau, K, Chau, N. Associations between quality of life and socioeconomic factors, functional impairments and dissatisfaction with received information and home-care services among survivors living at home two years after stroke onset. BMC Neurol. 2014;14:92. DOI: 10.1186/1471-2377-14-92.10.1186/1471-2377-14-92CrossRefGoogle ScholarPubMed
Urbach, DR. Measuring quality of life after surgery. Surg Innov. 2005;12:161–5. DOI: 10.1177/155335060501200216.10.1177/155335060501200216CrossRefGoogle ScholarPubMed
Shiraz, F, Rahtz, E, Bhui, K, Hutchison, I, Korszun, A. Quality of life, psychological wellbeing and treatment needs of trauma and head and neck cancer patients. Br J Oral Maxillofac Surg. 2014;52:513–7. DOI: 10.1016/j.bjoms.2014.03.019.10.1016/j.bjoms.2014.03.019CrossRefGoogle ScholarPubMed
Malcolm, JG, Rindler, RS, Chu, JK, et al. Early cranioplasty is associated with greater neurological improvement: a systematic review and meta-analysis. Neurosurgery. 2018;82:278–88. DOI: 10.1093/neuros/nyx182.10.1093/neuros/nyx182CrossRefGoogle ScholarPubMed
Hays, RD, Sherbourne, CD, Mazel, RM. The rand 36-item health survey 1.0. Health Econ. 1993;2:217–27. DOI: 10.1002/hec.4730020305.CrossRefGoogle ScholarPubMed
Brooks, R. EuroQol: the current state of play. Health Policy. 1996;37:53–72. DOI: 10.1016/0168-8510(96)00822-6.10.1016/0168-8510(96)00822-6CrossRefGoogle ScholarPubMed
Zaramo, TZ, Zelko, I, Ragland, D, et al. Can we do better at measuring patient-reported outcomes after cranioplasty? A systematic review. Neurosurg Rev. 2023;46:109. DOI: 10.1007/s10143-023-02006-3.10.1007/s10143-023-02006-3CrossRefGoogle ScholarPubMed
Morales-Gómez, JA, Garcia-Estrada, E, Leos-Bortoni, JE, et al. Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer. J Neurosurg. 2019;130:1721–7. DOI: 10.3171/2017.12.JNS172574.10.3171/2017.12.JNS172574CrossRefGoogle Scholar
Giese, H, Meyer, J, Engel, M, Unterberg, A, Beynon, C. Polymethylmethacrylate patient-matched implants (PMMA-PMI) for complex and revision cranioplasty: analysis of long-term complication rates and patient outcomes. Brain Inj. 2020;34:269–75. DOI: 10.1080/02699052.2019.1683895.10.1080/02699052.2019.1683895CrossRefGoogle ScholarPubMed
Ganau, M, Cebula, H, Fricia, M, et al. Surgical preference regarding different materials for custom-made allograft cranioplasty in patients with calvarial defects: results from an internal audit covering the last 20 years. J Clin Neurosci. 2020;74:98–103. DOI: 10.1016/j.jocn.2020.01.087.10.1016/j.jocn.2020.01.087CrossRefGoogle ScholarPubMed
Low, PH, Abdullah, JY, Abdullah, AM, Yahya, S, Idris, Z, Mohamad, D. Patient-specific reconstruction utilizing computer assisted three-dimensional modelling for partial bone flap defect in hybrid cranioplasty. J Craniofac Surg. 2019;30:e720–e723. DOI: 10.1097/SCS.0000000000005713.CrossRefGoogle ScholarPubMed
Intiso, D, Lombardi, T, Grimaldi, G, et al. Long-term outcome and health status in decompressive craniectomized patients with intractable intracranial pressure after severe brain injury. Brain Inj. 2011;25:379–86. DOI: 10.3109/02699052.2011.558046.CrossRefGoogle ScholarPubMed
Malmivaara, K, Kivisaari, R, Hernesniemi, J, Siironen, J. Cost-effectiveness of decompressive craniectomy in traumatic brain injuries: cost-effectiveness of decompressive craniectomy. Eur J Neurol. 2011;18:656–62. DOI: 10.1111/j.1468-1331.2010.03294.x.10.1111/j.1468-1331.2010.03294.xCrossRefGoogle ScholarPubMed
Malmivaara, K, Öhman, J, Kivisaari, R, Hernesniemi, J, Siironen, J. Cost-effectiveness of decompressive craniectomy in non-traumatic neurological emergencies: cost-effectiveness of decompressive craniectomy. Eur J Neurol. 2011;18:402–9. DOI: 10.1111/j.1468-1331.2010.03162.x.CrossRefGoogle ScholarPubMed
Honeybul, S. Complications of decompressive craniectomy for head injury. J Clin Neurosci. 2010;17:430–5. DOI: 10.1016/j.jocn.2009.09.007.10.1016/j.jocn.2009.09.007CrossRefGoogle ScholarPubMed
Grauwmeijer, E, Heijenbrok-Kal, MH, Ribbers, GM. Health-related quality of life 3 Years after moderate to severe traumatic brain injury: a prospective cohort study. Arch Phys Med Rehabil. 2014;95:1268–76. DOI: 10.1016/j.apmr.2014.02.002.CrossRefGoogle ScholarPubMed
Scholten, AC, Haagsma, JA, Andriessen, TMJC, et al. Health-related quality of life after mild, moderate and severe traumatic brain injury: patterns and predictors of suboptimal functioning during the first year after injury. Injury. 2015;46:616–24. DOI: 10.1016/j.injury.2014.10.064.10.1016/j.injury.2014.10.064CrossRefGoogle ScholarPubMed
Sundseth, J, Sundseth, A, Thommessen, B, et al. Long-term outcome and quality of life after craniectomy in speech-dominant swollen middle cerebral artery infarction. Neurocrit Care. 2015;22:6–14. DOI: 10.1007/s12028-014-0056-y.10.1007/s12028-014-0056-yCrossRefGoogle ScholarPubMed
Mustafa, MA, Richardson, GE, Gillespie, CS, et al. Health-related quality of life following cranioplasty – a systematic review. Br J Neurosurg. 2023;39:12–22. DOI: 10.1080/02688697.2023.2202244. Published online June 2, 2023.10.1080/02688697.2023.2202244CrossRefGoogle ScholarPubMed
Klieverik, VM, Robe, PA, Muradin, MSM, Woerdeman, PA. Cosmetic satisfaction and patient-reported outcome measures following cranioplasty after craniectomy – a prospective cohort study. Brain Spine. 2023;3:101767. DOI: 10.1016/j.bas.2023.101767.10.1016/j.bas.2023.101767CrossRefGoogle ScholarPubMed
Rauen, K, Reichelt, L, Probst, P, et al. Decompressive craniectomy is associated with good quality of life Up to 10 Years after rehabilitation from traumatic brain injury. Crit Care Med. 2020;48:1157–64. DOI: 10.1097/CCM.0000000000004387.10.1097/CCM.0000000000004387CrossRefGoogle ScholarPubMed
Mediratta, S, Lepard, JR, Barthélemy, EJ, Corley, J, Park, KB. Barriers to neurotrauma care in low- to middle-income countries: an international survey of neurotrauma providers. J Neurosurg. 2022;137:789–98. DOI: 10.3171/2021.9.JNS21916.10.3171/2021.9.JNS21916CrossRefGoogle ScholarPubMed
Punchak, M, Mukhopadhyay, S, Sachdev, S, et al. Neurosurgical care: availability and access in low-income and middle-income countries. World Neurosurg. 2018;112:e240–e254. DOI: 10.1016/j.wneu.2018.01.029.10.1016/j.wneu.2018.01.029CrossRefGoogle ScholarPubMed