The innovative work of Dr. Villiam Dallolio

Each year, only in Italy, almost 2000 cranial prosthesis are realized for operations of cranioplasty.
These operations, complex for their nature, are remarkable for an high failure percentage typically due to the raw manual techniques of realization of the prosthesis.
Today with additive manufacturing we already can create custom prosthesis. Even if some structures in Italy already have them in use they are still a weak solution for their costs and time not appropriate for the operating room.
Here is were enters the work of Dr. Villiam Dallolio, a neurosurgeon based in Lecco, Italy.
Since 1999 he’s been experimenting to reduce the distance between 3D printing and Neurosurgery.

An indirect process

The key point of the process developed is in the radical change of approach.
The idea is not fabricating directly the prosthesis with the 3D printer, with unsustainable costs and times, but thinking of a system that allows designing out of the operating room in an optimized process concluded by the realization of a scaffold(negative).
The starting point is a TC of the patient that can be translated with appropriate software in an high-fidelity 3D model. From here starts the modeling of the cranial prosthesis(positive) thanks to systems of mirroring and joining. In this phase we can think about the integration of some features. One example is the predisposition for the metal tabs. Another is designing a shape that can fix the muscular atrophy typical of many clinical cases.
From this shape, we model out the scaffold(negative) in which the material with be cast.
The scaffold, in certified material, is sterilized in the autoclave during the operation and allows the casing of bone cement. The strength of the system is the maintenance of the exact shape designed with the CAD.

Advantages of the system

With this method, the operation is faster and reduces a lot the risk of unfitting for the prosthesis thanks to the superior digital design.
The final material is bone cement that maintains all his wonderful properties, it’s easily available and already respects all the certifications.
The aim of the work is to replace gradually all the obsolete system today in use with this convenient technique that would radically improve the approach in the operations of cranioplasty.

Today Dr. Dallolio’s team is already providing the possibility to create cranial prosthesis with digital designing with the use of 3D printers and negative molds in silicone. Clearly is something not comparable to the convenience of the system described above, but is an half way.
Perspectives are wide and interesting, most of all because this kind of system would be suitable for every kind of implantable bone prosthesis, not only the ones for the skull.
The scaffold system is opening up to a whole new scenery in the surgery of tomorrow.