Imagine: New era of medicine marked by surgically implanted 3D printed skull

Only a decade ago, the idea of printing parts of the human body through 3D printing was still in the realm of science fiction, according to Dr. Gaurav Gupta, MD, Assistant professor of neurosurgery at Rutgers Robert Wood Johnson Medical School and Director, Cerebrovascular and Endovascular Neurosurgery, at Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital.

But on March 28, he successfully inserted a 3D printed skull implant into patient Christopher Cahill, of New Brunswick, during a four-hour surgery.

In early 2017, Cahill suffered an injury to the frontal lobe that resulted in life-threatening brain swelling. After performing emergency surgery to relieve the swelling, Gupta determined that Cahill’s skull was unusable because of an infection in the skull. Gupta turned to 3D printing as the best solution to replace the missing skull bone.

Through 3D printing, three-dimensional objects are manufactured from a two-dimensional digital file. It has become increasingly popular in the production of medical devices because of its precision and accuracy, according to Gupta.

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Gupta collaborated with medical device company DeputSynthese CMS to utilize 3D printing to develop a customized cranial skull implant for Cahill composed of a polymer, or plastic, known as polyetheretherketone (PEEK), which Gupta said was chosen for its strength, stability and biocompatibility.

He said, prior to 3D printing, surgeons used metal mesh to replace pieces of the skull, but it was not as strong or as precise.

“The 3D printed model is an exact and custom fit because it is created using the patient’s CT scan,” Gupta said. 

According to Gupta, PEEK is an inert substance that does not cause an inflammatory reaction, there are no known allergies to it, and it is not rejected by the body. The implants are also impact- and fracture-resistant, and do not erode or dissolve.

The patient said that while he was surprised and hopeful when Gupta suggested the use of 3D printing as a way to replace his skull, he had some apprehension.  

“I was nervous about what I would look like after the surgery," Cahill said. "However, I am happy that I look exactly the same and feel like myself again.”

Prior to the surgery, additional skin had to be grown on the patient’s head to cover the implant. Gupta turned to Dr. Tushar Patel, MD, plastic and reconstructive surgeon and partner at The Plastic Surgery Center, in Shrewsbury, to insert a tissue-expander that enabled Cahill to have enough skin for surgery.

Imagining the future

The 43-year-old Gupta admits that when he chose to specialize in neurosurgery, he could never have imagined what was ahead.   

“Ten years ago, we could not even think that we would be using this technology. However, we certainly always had the need for it,” he said. 

Gupta said that from his perspective, 3D printing is in its infancy.

“It's such a new area and everybody's very excited about it, and everybody likes to use the words 3D, 3D-printed body parts. But it must be understood that this is not a magic new substance that will increase your life or the fountain of youth,” Gupta said.

He said it is vitally important that the technology be used with caution — on the right patient for the right procedure.

“One part, one technology and one technique will not fit all," he said. "It has to be custom-tailored to the patient's well-being.”

Gupta said that what is most exciting for him is that this technology marks a new era in medicine.

“A lot of researchers are using parts to make tissue, skin, muscles, blood vessels. However, the material used for printing skin, muscles and any other tissue has to be the appropriate material, which is most likely other skin cells,” he said. “So you can use plastic.”

Gupta emphasized that the concept of 3D printing may be standardized across all of the medical modalities, but the material used in each area will be different.

“So you can have skin cells, or stem cells, that can be used to make layers of skin for instance,” he said.

Pivotal point in medicine

What is most thrilling and awesome to Gupta is the speed and the many ways human kind is now evolving.

“If you trace the evolution of mankind, it has been very slow with changes taking thousands of years." he said. "But in the 20th century, humans began using nonhuman or prosthetic devices for prolonging our lives, and in the last 50 years, this evolution has taken the form of artificial knees, hips, etc.”

Gupta said that this is the fastest human beings have evolved and we now have a chance to fight diseases that otherwise would have incapacitated human beings.

“There will be better cures for the diseases we are troubled with today, and for the diseases that are not cured, we will be able to offer solutions to live with those diseases more comfortably,” he said.

Gupta believes the machine-human interface will grow, along with artificial intelligence, as well as the use of nonhuman tissue.

“This is indeed a very exciting time," he said, "a time when the merging of the body's own tissues and devices that human beings have created can prolong our lives and make us more comfortable and disease free.” 

If you would like to be featured in the “Imagine” column, email MaryLynn Schiavi at marylynninc@ gmail.com.