• Peter A J Pijpker, Michiel Wagemakers, Joep Kraeima, Rob A Vergeer, Kuijlen Jos M A JMA Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., and Groen Rob J M RJM Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands..
• Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: p.a.j.pijpker@umcg.nl.
• World Neurosurg. 2019 Sep 1; 129: 148-156.

ObjectiveTo describe a new method for cranial reconstruction after posterior fossa craniectomy in the surgical treatment of Chiari 1 malformation through a technical note and presentation of 3 illustrative cases.Methods And MaterialsA virtual surgical planning workflow was established for planning posterior fossa decompression, designing the suboccipital reconstruction, and manufacturing a 3D-printed polymethylmethacrylate (PMMA) casting mold. The casting accuracy was assessed by conducting a phantom experiment, and clinical data were provided by means of 3 illustrative cases.ResultsThe accuracy of implant fabrication was found to be excellent, particularly when PMMA is introduced into the mold in a malleable state. In all 3 clinical cases, the implants were fabricated and positioned with success. Postoperative analysis revealed that accurate placement was achieved, with only minor deviation from the preoperative plan.Conclusions3D virtual surgical planning provides feasible tools for the planning of posterior fossa decompression and intraoperative fabrication of accurate patient-specific suboccipital cranioplasty.Copyright © 2019 Elsevier Inc. All rights reserved.

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