Customized PMMA Prostheses via 3D Printing for Post-Craniectomy Reconstruction: A Decade of Clinical Experience

Abstract This study evaluates the functional and aesthetic outcomes of cranioplasty using customized polymethyl methacrylate (PMMA) prostheses produced through a low-cost 3D printing technique. A clinical trial was conducted including 174 patients who underwent decompressive craniectomy and were later submitted to cranial reconstruction with custom-made PMMA implants between 2014 and 2024. Patients were followed for at least 3 months, and functional and aesthetic outcomes were assessed through a questionnaire applied preoperatively and at 6 months postoperatively. Among the 174 patients, 117 returned for postoperative evaluation, and 80 completed the outcome questionnaire. All patients demonstrated symptomatic improvement after cranioplasty. Aesthetic outcomes were rated as "excellent" by 73 patients and "very good" by 7. Significant postoperative improvement was observed in symptoms such as headache, local discomfort, dizziness, tinnitus, insomnia, and vibration intolerance (p < 0.001). Complications included seroma (49.4%), extradural hematoma (5.1%), dehiscence (2.8%), and seizures within the first 12 hours (8.6%). Reoperation occurred in 22.4% of cases. The infection rate was 5.7%, lower than rates reported in previous studies using PMMA. Cranioplasty with customized PMMA prostheses resulted in significant neurological symptom improvement and high patient satisfaction with cranial contour restoration. This technique demonstrated safety, reproducibility, and feasibility in a resource-limited public hospital setting, offering an accessible alternative for personalized cranial reconstruction.