Operative Neurosurgery 30:100–108, 2026
This single-center clinical series reports on 33 patients with monostotic cranial fibrous dysplasia treated with computer-assisted resection and reconstruction using patient-specific, 3D‑printed titanium cranioplasty implants. Methods detail high-resolution CT planning, surgeon‑engineer collaboration for CAD/CAM templates, intraoperative guidance, standardized perioperative care, and long-term radiological and FACE-Q patient‑reported outcome follow-up.
Results show complete tumor resections, favorable cosmetic outcomes, no postoperative complications or recurrences across extended follow-up, and high patient satisfaction; discussion addresses material selection, cost (≈$3000 per implant), production time, accessibility in low-resource settings, and the need for comparative studies.
Patient-Specific Titanium Implants: Customized, computer-aided design (CAD) and manufacturing (CAM) titanium implants enable precise resection and effective reconstruction for cranial fibrous dysplasia (CFD), resulting in excellent cosmetic outcomes and no postoperative complications or recurrences in a 33-patient series.
Surgical Process: Preoperative high-resolution CT scans and 3D modeling are used for surgical planning, including mirrored contralateral anatomy for symmetry; intraoperative templates guide tumor resection, and implants are secured with miniscrews.
Clinical Outcomes: All patients achieved complete tumor removal, satisfactory cosmetic results confirmed by postoperative CT, and no surgical site infections or cerebrospinal fluid leaks during a mean follow-up of 76–108 months.
Patient Satisfaction: High patient-reported satisfaction was observed, with FACE-Q scores indicating 84.8% of patients highly satisfied (score ≥85) and no patients dissatisfied with surgical outcomes.
Material Advantages: Titanium implants are favored for their biocompatibility, mechanical strength, and low infection rates compared to other materials like PEEK and PMMA, making them especially suitable for CFD reconstruction.
Cost and Accessibility: Average total cost per implant was $3000, with a 4-week production time; while feasible in middle-income settings, access remains limited in low-resource environments due to financial and infrastructural barriers.
Limitations: The study’s retrospective, single-center design, absence of a comparative cohort, and variable follow-up duration limit generalizability and long-term conclusions.
Future Directions: Broader adoption of CAD/CAM and patient-specific implants in craniofacial surgery may improve outcomes, but further comparative and cost-effectiveness studies are needed, especially in resource-constrained settings.
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