Robert Wood Johnson Medicine • Fall 2017 • 3-D Printed Skull Page 21

recalls, "I wondered, `Can they really do
this?' But Dr. Gupta saved my life once,
and I trusted him completely."

Dr. Gupta collaborated with a medical

device company, DePuy Synthes, to use
3-D printing to create a customized cra-
nial skull implant for Cahill. The
implant is made of polyetheretherketone
(PEEK), a thermoplastic polymer that is
chosen for its strength, stability, and biocompatibility. Prior
to 3-D printing, surgeons used metal mesh to replace pieces
of the skull, but it was not as strong or as precise. The model
created by 3-D printing is an exact custom fit because it uses
the patient's CT scan. It is the best choice in cases of signifi-

cant and irregular skull damage, as with Cahill. According to
a spokesman for the company, these implants have a better
anatomical fit, reduce operating time, and have more satisfy-
ing aesthetic results than traditional models. The implants
are also resistant to impacts and fractures.

Before the surgery, Cahill needed to grow additional skin

to cover the implant, because the skin around his frontal
lobe had contracted. To ensure the best possible aesthetic

result, Dr. Gupta enlisted the help of
Tushar Patel, MD, plastic and recon-
structive surgeon and partner at the
Plastic Surgery Center, to insert a skin
expander, which enabled Cahill to
have enough skin for surgery.

On March 28, Dr. Gupta and Dr.

Patel inserted the skull implant during
a four-hour surgery--shorter than a
traditional procedure due to the pre-

cise custom fit of the implant, which
allowed for fewer modifications dur-
ing the process. The surgery went
smoothly and Cahill recovered well,
living on his own within four months
of the surgery, with the help of Dr.
Gupta. Because the incision is behind

the hairline, the scars cannot be seen.

"I was nervous about what I would look like after the sur-

gery--I thought I would look like Frankenstein!" says
Cahill. "I was happy I looked exactly the same and felt like
myself again."

Robert Wood Johnson

MEDICINE 19

lthough Dr. Gupta has used 3-D

printing for brain surgery since 2012,

this was the biggest implant and also

the most complicated case he had

seen. When Cahill learned that part of

his skull would be replaced via 3-D

printing, he recalls, "I wondered, `Can

they really do this?' But Dr. Gupta

saved my life once, and I trusted him

completely."

Skull
Skull Skull