Schedule feasibility and workflow for additive manufacturing of titanium plates for cranioplasty reconstruction in canine skull tumors

Additive manufacturing has allowed for the creation of a patient-specific custom solution that can resolve many of the limitations previously reported for canine cranioplasty. The purpose of this pilot study was to determine the schedule feasibility and workflow in manufacturing patient-specific titanium implants for canines undergoing cranioplasty immediately following craniectomy. Computed tomography scans from patients with tumors of the skull were considered and 3 cases were selected. Images were imported into OsiriX MD image processing software and tumor margins were determined based on agreement between a board-certified veterinary radiologist and veterinary surgical oncologist. Virtual surgical planning was performed and a 5mm bone margin was selected. A defect was created to simulate the intraoperative defect. Stereolithography format files of the skulls were imported into Renishaw Additive-manufacture for Design-led Efficient Patient Treatment (ADEPT) software. In collaboration with medical solution center, Additive Design in Surgical Solutions (ADEISS), a custom titanium plate was designed with the input of an applications engineer and veterinary surgical oncologist. Plates were printed in titanium and postprocessed at ADEISS. Total planning time was approximately 2 hours with a manufacturing time of 2 weeks. Based on the findings of this study, with access to an advanced 3D metal printing medical solution center that can provide advanced software and printing, patient-specific additive manufactured titanium implants can be planned, created, processed, shipped and sterilized for patient use within a 3-week turnaround.