Neurosurgeons successfully implant 3D printed skull

3D printed skull implant Photo Credit: UMC Utrecht

3D printed skull implant Photo Credit: UMC Utrecht

A 22-year-old woman from the Netherlands who suffers from a chronic bone disorder — which has increased the thickness of her skull from 1.5cm to 5cm, causing reduced eyesight and severe headaches — has had the top section of her skull removed and replaced with a 3D printed implant.

The skull was made specifically for the patient using an unspecified durable plastic. Since the operation, the patient has gained her sight back entirely, is symptom-free and back to work. It is not known whether the plastic will require replacing at a later date or if it will last a lifetime.

The operation was performed by a team of neurosurgeons at the University Medical Centre Utrecht and the university claims this is this first instance of a successful 3D printed cranium that has not been rejected by the patient.

It is hoped this technique can also be used for patients with other bone disorders or to repair severely damaged skulls after an accident or tumour.

Source: Wired UK

Gabrielle Giffords’ neurosurgeon speaks about her surgery


G. Michael Lemole Jr., M.D., keynote speaker at Health Journalism 2011

G. Michael Lemole Jr., M.D., chief of neurosurgery at the University of Arizona Department of Surgery and University Medical Center, found himself in the media spotlight after he performed brain surgery on U.S. Rep. Gabrielle Giffords after she sustained a gunshot wound to the head in Tucson on Jan. 8.

As the keynote speaker at Health Journalism 2011, he recounted the treatment of the congresswoman earlier this year and his experience working with the media:

Everyone made a big deal of what we did, but it’s what we do everyday … This is academic medicine at its best

In the operation, Lemole and Martin E. Weinand, M.D., removed part of Gifford’s skull to allow her brain to swell, as well as removing dead brain tissue and skull fragments caused by the bullet.

 “We basically take part of the skull off and let the swollen brain relax,” explained Lemole. The procedure can relieve pressure on the brain but it can also worsen edema – the build-up of fluid that can cause an “outward herniation.” They also had to remove damaged parts of the brain to “save the good brain underneath.”

The procedure is informed by data gathered during surgery on soldiers injured in the Iraq war, he said. At some point, surgeons will replace the bone or use a prosthetic.

On Jan. 15, Lemole repaired Giffords’ orbital roof fracture through a skull base approach.  The last surgery that Giffords received was a ventriculostomy, which measured intracranial pressure and drained fluid in the brain. He credits the use of growing use of simulation in surgical training for allowing doctors to successfully perform operations like the ventriculostomy. In addition to simulation training, Lemole said the “flawless” EMT response and the multidisciplinary nature of trauma team combined to improve Giffords’ odds.

Lemole supervised the congresswoman’s care until she was released to a Houston rehabilitation hospital on Jan. 21 and during  this time, was available to the media. “We strategized with ourselves, administrators, and with the family. The family asked us to get the correct information out,” he said. Lemole said he chose his words carefully. “I don’t think I gave a rosy account,” he said, describing his careful use of the term “functional recovery” instead of terms like “full recovery” or “back to normal.”

Giffords Progress

Giffords outcome was impossible to predict at the outset of her injury. Generally, the odds of dying from a gunshot wound to the head range from 56 to 94 percent, Lemole said. If the path of the bullets goes through the geographic center of the brain, through the ventricles or through multiples lobes, the prognosis is not good. In Giffords’ case, the bullet did not cross from one side of the brain to the other, but travelled through the left side. The patient’s level of consciousness at admission is another factor –  at the time, Lemole was quoted as saying that Giffords was able to follow simple commands from the doctors.

The Arizona Republic newspaper reports “that she can stand on her own and walk a little but is working to improve her gait.” The use of her right arm and leg “is limited but improving” . Longer sentences frustrate her and she speaks most often in a single word or declarative phrases. She longs to leave the rehab center, repeating “I miss Tucson” and wheeling herself to the doors at the end of the hall to peer out. When that day comes, Giffords told her nurse, she plans to “walk a mountain.”


Boston Blog

Health Journalism Blog

The Arizona Republic

How did Gabrielle Giffords survive gunshot wound to head?

Rep Gabrielle Giffords

Rep Gabrielle Giffords

Initial reports on the shooting of American politician, Gabrielle Giffords, at the weekend, implied that she had been shot dead. The fact that she had received a gunshot wound through the back of her head made it seem sadly likely that this was the case. However, Giffords, although in a critical condition has survived the shooting, and her doctors are “cautiously optimistic” about her survival.

While around two-thirds of patients with a gunshot wound to the head don’t live, one-third do (although only 50% of those patients survive longer than 30 days).  Of course long-term neurological function in the survivors is another story.

In Giffords’ case, the bullet shot through the back of the left side of her head. If it had passed through the midline, the likelihood of survival would have been less likely.

According to CNN’s Chief Medical Correspondent Dr. Sanjay Gupta, the injury was a “through and through” injury, meaning there was both an entry and exit wound – meaning  some of the energy of the bullet was dissipated into space, as opposed to all within her cranial cavity.

Dr Gupta also reports that neurosurgeon, Dr. Michael Lemole, performed a craniectomy (surgical removal of a portion of the cranium) to prevent the brain swelling.  By removing portions of the skull, the brain has extra room to swell. Incidentally, the bone that’s removed is saved, and put back in the head during a future operation.

While Giffords is clearly not out of danger yet, let us hope that the signs are good for her recovery.