Noninvasive 3D-head-scan used for 3D-printed customized helm by patient undergoing decompressive hemicraniectomy

Fabian Kropla ^1* Johannes Wach ¹ Dirk Winkler ¹ Ronny Grunert ^1,2 Erdem Güresir ¹ Martin Vychopen ¹

• ¹ Department for Neurosurgery, University Hospital Leipzig, Leipzig, Lower Saxony, Germany
• ² Fraunhofer Institute for Machine Tools and Forming Technology, 02763 Zittau, SN, Germany, Zittau, Germany

Decompressive hemicraniectomy (DC) is a procedure used to treat elevated, therapy-refractory intracranial pressure. Despite the severity of the underlying pathology, selected patients quickly regain mobility and are at risk of secondary injury due to the post-craniotomy defect. A 3D-printed helmet offers a quickly available and safe solution. Up to now, postoperative CT scans have been used as a template for helmet construction. In this study, we present an alternative helmet construction using a non-invasive 3D scan (ArtecLeo, Artec3D), which is used to capture craniometrics data, plan the shape of the helmet, and compare it with routinely performed CT scans. A significant difference in defect displacement between supine scans and standing or sitting scans is evident, which is quantified.We included six patients who underwent decompressive craniectomy due to therapyrefractory elevation of intracranial pressure as a consequence of following pathologies: large intracerebral hemorrhage, large cerebral infarction, sever traumatic brain injury and poor grade subarachnoid hemorrhage. All patients underwent 3-D scan and subsequently, a helmet was created to cover the craniectomy area.A surface heat-map comparison was performed to demonstrate the differences between the data obtained by 3-D scan (lying and sitting position) and CT-scan. Furthermore, the heat-map demonstrates the frontal and posterior surface difference between CT-scan and sitting position. Comparing the lying position 3-D scan and CT-scan, we were able to demonstrate a tissue shift, mainly in cranial and frontal areas.We demonstrated that non-invasive 3D-scan (Artec3D) is a feasible alternative to scan the head of the patients after DHC in order to construct a 3D-printed Helm. According to the heat-map analysis, it seems to be more reliable data assessment method in independently moving patients.