• Chieh-Tsai Wu, Ting-Chen Lu, Chun-Sheng Chan, and Tzu-Chin Lin.
• Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: woodie2@cgmh.org.tw.
• World Neurosurg. 2021 Mar 1; 147: e416-e427.

ObjectiveTo describe a novel system workflow to design and manufacture patient-specific three-dimensional (3D) printing jigs for single-stage skull bone tumor excision and reconstruction and to present surgical outcomes of 14 patients.MethodsA specific computer-aided design/computer-aided manufacturing software and hardware system was set up, including a virtual surgical planning subsystem and a 3D printing-associated manufacturing subsystem. Computed tomography data of the patient's skull were used for 3D rendering of the skull and tumor. The output of patient-specific designing included a 3D printing guide for tumor resection and a 3D printing model of the bone defect after tumor excision. A polymethyl methacrylate implant was fabricated preoperatively and used for repair.ResultsThe specific 3D printing guide was used to design intraoperative jigs and implants for 14 patients (age range, 1-72 years) with skull bone tumors. In all cases, the cutting jig allowed precise excision of tumor and bone, and implants were exact fits for the defects created. All operative results were successful, without intraoperative or postoperative complications. Postoperative computed tomography scans were obtained for analysis. Postoperative 3D measurement of the skull symmetry index (cranial vault asymmetry index) showed significant improvement of head contour after surgery.ConclusionsThe computer-aided design/computer-aided manufacturing system described allows definitive preoperative planning and fabrication for treatment of skull bone tumors. Apparent benefits of the method include more accurate determination of surgical margins and better oncological outcomes.Copyright © 2020 Elsevier Inc. All rights reserved.

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