StrokeCAPSIDNCT02828306
Computer Based Algorithm for Patient Specific Implants for Cranioplasty in Patients With Skull Defects
An observational study of Stroke and Head Trauma, run by Insel Gruppe AG, University Hospital Bern at 1 site in Switzerland.
Trial summary
Patients with skull defects after craniotomy for example tumor resection, head trauma, stroke, need a reimplantation of the bone afterwards. For some circumstances, their own bone cannot be reimplanted due to infection, tumor infiltration, damage to the bone, or aseptic bone necrosis. Read more about this study
- Who is it for?
- Ages 18 to 89 years
- Conditions the study is for
- Stroke, Head Trauma
- What is being tested?
- Patient Specific Implant
- How many people
- 15 participants
- Where
- 1 siteSwitzerland
- Study dates
- Sep 2016to Aug 2019
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 89 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Patients with skull defects after craniotomy for example tumor resection, head trauma, stroke, need a Patient Specific Implant (PSI).
Who may be able to join
- Patients with skull defects due to craniotomy who need a Patient Specific Implant (PSI) of the skull
- Age older than 18 and less than 90 years
- Provided written informed consent
Who cannot join
- Contraindications to the class of drugs under study, e.g. known hypersensitivity or allergy to Palacos
- Women who are pregnant or breast feeding
- Intention to become pregnant during the course of the study
- Known coagulopathy
- Severe disease with limited life expectancy of less than one year
Trial locations and contacts
1 site in 1 country.
Switzerland1 site
Dep. of Neurosurgery, Bern University Hospital
Bern, 3010
About this study
Official title: Computer Based Algorithm for Patient Specific Implants for Cranioplasty in Patients With Skull Defects: a Prospective Clinical Trial
Patients with skull defects after craniotomy for example tumor resection, head trauma, stroke, need a reimplantation of the bone afterwards. For some circumstances, their own bone cannot be reimplanted due to infection, tumor infiltration, damage to the bone, or aseptic bone necrosis. In these cases a Patient Specific Implant (PSI) needs to be designed to fit into the patient's skull defect.
The design of the PSI is based on the preoperative CT-scan of the patient's head with the skull defect, the imaging data set is uploaded and processed with IPlanNet software by BrainLab®. With the help of the software, a 3D model of a negative mould of the PSI is designed and printed. In the operation room, the PSI is fabricated under sterile conditions using the PSI mould. The design of the PSI mould with the help of IPlanNet is demanding and takes some few hours depending on the complexity of the case to be designed. In certain cases the accuracy of the fabricated PSI mould is not optimal, so that the surgeon intraoperatively has to adapt for the inaccuracy to achieve the best cosmetic and functional results at the expense of the operation duration, a known risk factor for postoperative wound infection and other perioperative complications.
Therefore, the investigators have developed an automated computer-based algorithm for PSI design (CAPSID). With the help of this tool, an accurate PSI and its corresponding mould can be calculated and designed based on the preoperative CT scan of the patient within 5-15 minutes and the corresponding mould can be printed. This step is automated and thus, independent of the neurosurgeons experience and skills in 3D processing software. The mould can be used for intraoperative fabrication of the implant under sterile conditions in the common way as described above. The possible advantages of the clinical establishment of this procedure would be a higher accuracy of the PSI compared to the conventional PSI fabrication method with better cosmetic results, lower costs and faster availability and production leading to shorter waiting time for the patient, and as a consequence of the higher accuracy leading to shorter operation time, with a reduction of risk of operative adverse events for the patient. Furthermore, the proof of practicability of this new method, could lead to new concepts in the field of Computer-based Patient Specific Implants in modern medicine in general.
Read the detailed description
Patients with skull defects after craniotomy for example tumor resection, head trauma, stroke, need a reimplantation of the bone afterwards. For some circumstances, their own bone cannot be reimplanted due to infection, tumor infiltration, damage to the bone, or aseptic bone necrosis. In these cases a Patient Specific Implant (PSI) needs to be designed to fit into the patient's skull defect. Several materials are currently used such as titanium, poly-ether-ether-ketone (PEEK) or poly-methylmethyl-acrylate (PMMA) for PSI fabrication. At the moment, PSI are commercially available from different companies (DePuy Synthes®, EOS®, Xilloc®). Apart from the high costs of commercially available PSI, it takes usually several weeks until the designed and manufactured PSI is delivered to the hospital ready for reimplantation.
On the other hand, a method for software-based PSI design and intraoperative fabrication of the PSI under sterile conditions was described by Stieglitz et al. This method is currently used in everyday clinics in the department of neurosurgery in Bern. In short summary, the design of the PSI is based on the preoperative CT-scan of the patient's head with the skull defect, the imaging data set is uploaded and processed with IPlanNet software by BrainLab®. With the help of the software, a 3D model of a negative mould of the PSI is designed and printed. In the operation room, the PSI is fabricated under sterile conditions using the PSI mould. The design of the PSI mould with the help of IPlanNet is demanding and takes some few hours depending on the complexity of the case to be designed. In certain cases the accuracy of the fabricated PSI mould is not optimal, so that the surgeon intraoperatively has to adapt for the inaccuracy to achieve the best cosmetic and functional results at the expense of the operation duration, a known risk factor for postoperative wound infection and other perioperative complications.
Therefore, the investigators have developed an automated computer-based algorithm for PSI design (CAPSID). With the help of this tool, an accurate PSI and its corresponding mould can be calculated and designed based on the preoperative CT scan of the patient within 5-15 minutes and the corresponding mould can be printed. This step is automated and thus, independent of the neurosurgeons experience and skills in 3D processing software. The mould can be used for intraoperative fabrication of the implant under sterile conditions in the common way as described above. The possible advantages of the clinical establishment of this procedure would be a higher accuracy of the PSI compared to the conventional PSI fabrication method with better cosmetic results, lower costs and faster availability and production leading to shorter waiting time for the patient, and as a consequence of the higher accuracy leading to shorter operation time, with a reduction of risk of operative adverse events for the patient. Furthermore, the proof of practicability of this new method, could lead to new concepts in the field of Computer-based Patient Specific Implants in modern medicine in general. A clinical trial is necessary to proof the advantages and practicability of the investigators' concept of computer-based algorithm for PSI design (CAPSID) for patients with skull defects.
- Conditions
- Stroke, Head Trauma
- Being tested
- Patient Specific Implant
- Keywords
- stroke, head trauma, Patient Specific Implant, skull defect
- Medical subject headings
- Stroke, Craniocerebral Trauma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Patient Specific ImplantOther
Implantation of Patient Specific Implant
| Study group | Role | What they receive |
|---|---|---|
| Patients with skull defects | Patients with skull defects after craniotomy for example tumor resection, head trauma, stroke which need a Patient Specific Implant. Receives: Other: Patient Specific Implant |
What is being measured
The primary outcome is the main question the study is designed to answer.
Number of patients where there is no need to adapt the PSI's edges
Measured: 6 weeks after surgery by standardised questionnaire
Number of patients where there is no need to augment/fill clefts between the PSI and patient´s bone
Measured: 6 weeks after surgery by standardised questionnaire
Number of patients where there is no need to discard the PSI and fabricate a new PSI
Measured: 6 weeks after surgery by standardised questionnaire
Secondary outcomes (9)
Operation duration
Measured: intraoperative
Patient's satisfaction measured by questionary
Measured: 6 weeks
infection rate
Measured: day 1-3 after OP, at 6 weeks
postoperative haemorrhage
Measured: day 1-3 after OP, at 6 weeks
postoperative cerebrospinal fluid leakage
Measured: day 1-3 after OP, at 6 weeks
PSI-displacement
Measured: day 1-3 after OP, at 6 weeks
need for reoperation
Measured: day 1-3 after OP, at 6 weeks
Accuracy of the PSI determined by volumetric analysis of the patient´s post-implantation CT scan (dice similarity index)
Measured: 3 days after surgery
Accuracy of the PSI determined by volumetric analysis of the patient´s post-implantation CT scan (volumetric inaccuracy index)
Measured: 3 days after surgery
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Jul 2016 (estimated)
- Study startSep 2016
- Primary completionJun 2019
- Study completionAug 2019
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for StrokeStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case-control
- Time perspective
- Prospective
- Enrolment
- 15 participants (actual)
Sponsor and investigators
- Lead sponsor
- Insel Gruppe AG, University Hospital Bern
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Philippe Schucht, MD, Principal investigator, University Hospital Inselspital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02828306
- Sponsor's protocol ID
- CAPSID
- Acronym
- CAPSID
- Status last verified
- Sep 2019
- First submitted
- 21 Jun 2016
- Last updated
- 4 Sep 2019
- Results posted
- No
- Data monitoring committee
- No
- Individual data sharing
- Yes
Publications
Della Puppa A, Rustemi O, Gioffre G, Troncon I, Lombardi G, Rolma G, Sergi M, Munari M, Cecchin D, Gardiman MP, Scienza R. Predictive value of intraoperative 5-aminolevulinic acid-induced fluorescence for detecting bone invasion in meningioma surgery. J Neurosurg. 2014 Apr;120(4):840-5. doi: 10.3171/2013.12.JNS131642. Epub 2014 Jan 10.
PubMed 24410157Lassen B, Helseth E, Ronning P, Scheie D, Johannesen TB, Maehlen J, Langmoen IA, Meling TR. Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery. 2011 May;68(5):1259-68; discussion 1268-9. doi: 10.1227/NEU.0b013e31820c0441.
PubMed 21273920Stieglitz LH, Fung C, Murek M, Fichtner J, Raabe A, Beck J. What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients. Acta Neurochir (Wien). 2015 Feb;157(2):275-80. doi: 10.1007/s00701-014-2310-7. Epub 2014 Dec 24.
PubMed 25534126Chim H, Gosain AK. Biomaterials in craniofacial surgery: experimental studies and clinical application. J Craniofac Surg. 2009 Jan;20(1):29-33. doi: 10.1097/SCS.0b013e318190dd9e.
PubMed 19164984Stieglitz LH, Gerber N, Schmid T, Mordasini P, Fichtner J, Fung C, Murek M, Weber S, Raabe A, Beck J. Intraoperative fabrication of patient-specific moulded implants for skull reconstruction: single-centre experience of 28 cases. Acta Neurochir (Wien). 2014 Apr;156(4):793-803. doi: 10.1007/s00701-013-1977-5. Epub 2014 Jan 18.
PubMed 24442601
Study at a glance
From the registry record, last updated by the sponsor on 4 Sep 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Computer Based Algorithm for Patient Specific Implants for Cranioplasty in Patients With Skull Defects: a Prospective Clinical Trial
- ClinicalTrials.gov ID
- NCT02828306
- Acronym / sponsor ID
- CAPSID / CAPSID
- Conditions
- Stroke, Head Trauma
- Keywords
- stroke, head trauma, Patient Specific Implant, skull defect
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 15 participants (actual)
- Lead sponsor
- Insel Gruppe AG, University Hospital BernUniversity, hospital or other
- Study start
- Sep 2016
- Primary completion
- Jun 2019 (actual)
- Study completion
- Aug 2019 (actual)
- First posted
- 11 Jul 2016 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Patients with skull defects after craniotomy for example tumor resection, head trauma, stroke, need a reimplantation of the bone afterwards. For some circumstances, their own bone cannot be reimplanted due to infection, tumor infiltration, damage to the bone, or aseptic bone necrosis. In these cases a Patient Specific Implant (PSI) needs to be designed to fit into the patient's skull defect.
The design of the PSI is based on the preoperative CT-scan of the patient's head with the skull defect, the imaging data set is uploaded and processed with IPlanNet software by BrainLab®. With the help of the software, a 3D model of a negative mould of the PSI is designed and printed. In the operation room, the PSI is fabricated under sterile conditions using the PSI mould. The design of the PSI mould with the help of IPlanNet is demanding and takes some few hours depending on the complexity of the case to be designed. In certain cases the accuracy of the fabricated PSI mould is not optimal, so that the surgeon intraoperatively has to adapt for the inaccuracy to achieve the best cosmetic and functional results at the expense of the operation duration, a known risk factor for postoperative wound infection and other perioperative complications.
Therefore, the investigators have developed an automated computer-based algorithm for PSI design (CAPSID). With the help of this tool, an accurate PSI and its corresponding mould can be calculated and designed based on the preoperative CT scan of the patient within 5-15 minutes and the corresponding mould can be printed. This step is automated and thus, independent of the neurosurgeons experience and skills in 3D processing software. The mould can be used for intraoperative fabrication of the implant under sterile conditions in the common way as described above. The possible advantages of the clinical establishment of this procedure would be a higher accuracy of the PSI compared to the conventional PSI fabrication method with better cosmetic results, lower costs and faster availability and production leading to shorter waiting time for the patient, and as a consequence of the higher accuracy leading to shorter operation time, with a reduction of risk of operative adverse events for the patient. Furthermore, the proof of practicability of this new method, could lead to new concepts in the field of Computer-based Patient Specific Implants in modern medicine in general.
Detailed description
Patients with skull defects after craniotomy for example tumor resection, head trauma, stroke, need a reimplantation of the bone afterwards. For some circumstances, their own bone cannot be reimplanted due to infection, tumor infiltration, damage to the bone, or aseptic bone necrosis. In these cases a Patient Specific Implant (PSI) needs to be designed to fit into the patient's skull defect. Several materials are currently used such as titanium, poly-ether-ether-ketone (PEEK) or poly-methylmethyl-acrylate (PMMA) for PSI fabrication. At the moment, PSI are commercially available from different companies (DePuy Synthes®, EOS®, Xilloc®). Apart from the high costs of commercially available PSI, it takes usually several weeks until the designed and manufactured PSI is delivered to the hospital ready for reimplantation.
On the other hand, a method for software-based PSI design and intraoperative fabrication of the PSI under sterile conditions was described by Stieglitz et al. This method is currently used in everyday clinics in the department of neurosurgery in Bern. In short summary, the design of the PSI is based on the preoperative CT-scan of the patient's head with the skull defect, the imaging data set is uploaded and processed with IPlanNet software by BrainLab®. With the help of the software, a 3D model of a negative mould of the PSI is designed and printed. In the operation room, the PSI is fabricated under sterile conditions using the PSI mould. The design of the PSI mould with the help of IPlanNet is demanding and takes some few hours depending on the complexity of the case to be designed. In certain cases the accuracy of the fabricated PSI mould is not optimal, so that the surgeon intraoperatively has to adapt for the inaccuracy to achieve the best cosmetic and functional results at the expense of the operation duration, a known risk factor for postoperative wound infection and other perioperative complications.
Therefore, the investigators have developed an automated computer-based algorithm for PSI design (CAPSID). With the help of this tool, an accurate PSI and its corresponding mould can be calculated and designed based on the preoperative CT scan of the patient within 5-15 minutes and the corresponding mould can be printed. This step is automated and thus, independent of the neurosurgeons experience and skills in 3D processing software. The mould can be used for intraoperative fabrication of the implant under sterile conditions in the common way as described above. The possible advantages of the clinical establishment of this procedure would be a higher accuracy of the PSI compared to the conventional PSI fabrication method with better cosmetic results, lower costs and faster availability and production leading to shorter waiting time for the patient, and as a consequence of the higher accuracy leading to shorter operation time, with a reduction of risk of operative adverse events for the patient. Furthermore, the proof of practicability of this new method, could lead to new concepts in the field of Computer-based Patient Specific Implants in modern medicine in general. A clinical trial is necessary to proof the advantages and practicability of the investigators' concept of computer-based algorithm for PSI design (CAPSID) for patients with skull defects.
Study design
- Observational model
- Case-control
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Patients with skull defects | – | Other: Patient Specific ImplantPatients with skull defects after craniotomy for example tumor resection, head trauma, stroke which need a Patient Specific Implant. |
Who may qualify
- Ages
- 18 to 89 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients with skull defects after craniotomy for example tumor resection, head trauma, stroke, need a Patient Specific Implant (PSI).
Key inclusion criteria (3 listed)
- Patients with skull defects due to craniotomy who need a Patient Specific Implant (PSI) of the skull
- Age older than 18 and less than 90 years
- Provided written informed consent
Key exclusion criteria (5 listed)
- Contraindications to the class of drugs under study, e.g. known hypersensitivity or allergy to Palacos
- Women who are pregnant or breast feeding
- Intention to become pregnant during the course of the study
- Known coagulopathy
- Severe disease with limited life expectancy of less than one year
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Patient Specific ImplantImplantation of Patient Specific Implant | Other | Patients with skull defects |
Primary outcome
Number of patients where there is no need to adapt the PSI's edges
Time frame: 6 weeks after surgery by standardised questionnaire
Number of patients where there is no need to augment/fill clefts between the PSI and patient´s bone
Time frame: 6 weeks after surgery by standardised questionnaire
Number of patients where there is no need to discard the PSI and fabricate a new PSI
Time frame: 6 weeks after surgery by standardised questionnaire
9 secondary outcomes
Operation duration
Time frame: intraoperative
Patient's satisfaction measured by questionary
Time frame: 6 weeks
infection rate
Time frame: day 1-3 after OP, at 6 weeks
postoperative haemorrhage
Time frame: day 1-3 after OP, at 6 weeks
postoperative cerebrospinal fluid leakage
Time frame: day 1-3 after OP, at 6 weeks
PSI-displacement
Time frame: day 1-3 after OP, at 6 weeks
need for reoperation
Time frame: day 1-3 after OP, at 6 weeks
Accuracy of the PSI determined by volumetric analysis of the patient´s post-implantation CT scan (dice similarity index)
Time frame: 3 days after surgery
Accuracy of the PSI determined by volumetric analysis of the patient´s post-implantation CT scan (volumetric inaccuracy index)
Time frame: 3 days after surgery
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Sep 2019.
- Background: PubMed 24410157Della Puppa A, Rustemi O, Gioffre G, Troncon I, Lombardi G, Rolma G, Sergi M, Munari M, Cecchin D, Gardiman MP, Scienza R. Predictive value of intraoperative 5-aminolevulinic acid-induced fluorescence for detecting bone invasion in meningioma surgery. J Neurosurg. 2014 Apr;120(4):840-5. doi: 10.3171/2013.12.JNS131642. Epub 2014 Jan 10.
- Background: PubMed 21273920Lassen B, Helseth E, Ronning P, Scheie D, Johannesen TB, Maehlen J, Langmoen IA, Meling TR. Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery. 2011 May;68(5):1259-68; discussion 1268-9. doi: 10.1227/NEU.0b013e31820c0441.
- Background: PubMed 25534126Stieglitz LH, Fung C, Murek M, Fichtner J, Raabe A, Beck J. What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients. Acta Neurochir (Wien). 2015 Feb;157(2):275-80. doi: 10.1007/s00701-014-2310-7. Epub 2014 Dec 24.
- Background: PubMed 19164984Chim H, Gosain AK. Biomaterials in craniofacial surgery: experimental studies and clinical application. J Craniofac Surg. 2009 Jan;20(1):29-33. doi: 10.1097/SCS.0b013e318190dd9e.
- Background: PubMed 24442601Stieglitz LH, Gerber N, Schmid T, Mordasini P, Fichtner J, Fung C, Murek M, Weber S, Raabe A, Beck J. Intraoperative fabrication of patient-specific moulded implants for skull reconstruction: single-centre experience of 28 cases. Acta Neurochir (Wien). 2014 Apr;156(4):793-803. doi: 10.1007/s00701-013-1977-5. Epub 2014 Jan 18.
- Individual participant dataSharing planned: Yes
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Philippe Schucht, MD principal investigator
University Hospital Inselspital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Stroke and Head Trauma, run by Insel Gruppe AG, University Hospital Bern at 1 site in Switzerland.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Sep 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Number of patients where there is no need to adapt the PSI's edges (time frame: 6 weeks after surgery by standardised questionnaire). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02828306, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Sep 2019.