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18 Robert WoodJohnson
two months in and out of con-
sciousness, Chris Cahill, a resi-
dent of New Brunswick, woke up at Kessler Rehab-
ilitation Center confused about where he was and what
had happened to him. He was found unconscious from
unknown trauma on a street in New Brunswick, resulting in
severe injuries to his frontal lobe that caused brain swelling
so dramatic it was life-threatening, explains Dr. Gupta. He
performed emergency surgery to relieve the swelling, with
the intent of replacing the skull afterward. However, the
patient's skull was infected and therefore was unusable. At
that point, Dr. Gupta decided the best solution to replace the
missing skull bone was to use 3-D printing.
The 3-D printing process produces three-dimensional
objects from a two-dimensional digital file. It has become
popular for medical devices because of its precision and
accuracy. For Cahill, 3-D printing, based on his CT scan,
was used to create a model of his skull and then a custom
implant to replace the missing piece. "The model was used
for practice," says Dr. Gupta. "Once the skull implant was
printed, millimeter by millimeter, we matched the new
implant to the skull model, ensuring a perfect fit."
Two separate implants were printed because the area of
the skull was so large, and Dr. Gupta then bonded them
together. Although he has used 3-D printing for brain sur-
gery 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