{"id":4956,"date":"2019-04-02T12:00:19","date_gmt":"2019-04-02T16:00:19","guid":{"rendered":"https:\/\/adsknews.autodesk.com\/?post_type=stories&#038;p=4956"},"modified":"2019-06-10T19:24:00","modified_gmt":"2019-06-10T23:24:00","slug":"designing-custom-skull-implants","status":"publish","type":"stories","link":"https:\/\/adsknews.autodesk.com\/en\/stories\/designing-custom-skull-implants\/","title":{"rendered":"Granta\u2019s Custom Skull Implants Are Designed and Made in Mexico, With Love"},"content":{"rendered":"<p><iframe loading=\"lazy\" class=\"wp-embedded-content\" sandbox=\"allow-scripts\" security=\"restricted\" title=\"Granta&#039;s Custom Skull Implants Break the Mold for Head Trauma Treatment [Archived on March 25, 2019] [Archived on March 27, 2019] Video\" src=\"https:\/\/fast.wistia.net\/embed\/iframe\/262t83b9hv?dnt=1&#038;videoFoam=true#?secret=bUNLQenimk\" data-secret=\"bUNLQenimk\" frameborder=\"0\" scrolling=\"no\" width=\"100%\" height=\"100%\"><\/iframe> On September 18<sup>th<\/sup>, 2018, Carlos Monroy walked into an operating room at Espa\u00f1ol Hospital in Mexico City, and what happened next changed his life forever. He was there because he had made the small piece of plastic that would be carefully implanted onto the skull of the patient lying on the table. The patient\u2019s name was Adriana, and when Carlos saw her the following day in her recovery room, he knew from the smile on her face that her life had changed forever, too. \u201cSince I was little, I wanted to help people,\u201d says Carlos. As a young student in Mexico City, he worked hard in school, earning degrees in industrial design and aeronautical engineering before finding a job at General Electric Aviation working on aircraft engines. He then decided to move to the UK, where he completed a PhD and two post doctorates at the University of Cambridge and Swansea University that led him to do more work in the automotive and medical device industries. It was during this time that he came up with the idea for his company, <a href=\"http:\/\/www.granta.mx\/preguntas-frecuentes\/\">Granta<\/a>, named after the <a href=\"https:\/\/en.wikipedia.org\/wiki\/River_Granta\">stretch of river<\/a> in the English town of Cambridge where Carlos had studied. <div id=\"attachment_4963\" style=\"width: 856px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4963\" class=\"wp-image-4963 size-full\" src=\"https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/Carlos_Granta.png\" alt=\"\" width=\"846\" height=\"511\" srcset=\"https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/Carlos_Granta.png 846w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/Carlos_Granta-300x181.png 300w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/Carlos_Granta-700x423.png 700w\" sizes=\"auto, (max-width: 846px) 100vw, 846px\" \/><p id=\"caption-attachment-4963\" class=\"wp-caption-text\">Carlos founded his company, Granta, to fulfill his lifelong dream of helping people. Image credit: Di\u00e1logo Ejecutivo<\/p><\/div> <strong>Making it in Mexico<\/strong> The objective of the company, which Carlos founded in Mexico, would be to take all of the knowledge he\u2019d gained so far in his career and to channel it back into his childhood dream of helping people. He realized that his work with materials in the automotive sector, paired with some of the latest technological advancements in digital fabrication, could be applied to medical devices and that it could be a real, working business. <\/p>\n<blockquote><p>It hasn\u2019t been easy\u2014starting a company is difficult, and it\u2019s even more difficult to start a company in Mexico, and even more difficult to start a company in the health sector in Mexico.<\/p><\/blockquote>\n<p> Granta would design and fabricate customized bone implants for patients who desperately needed them. To start, they would make implants for the human skull. \u201cIt\u2019s the easiest place for us to start because it\u2019s so important to protect the brain, but you don\u2019t have any other joints or articulations,\u201d Carlos explains. \u201cIt\u2019s there to protect, and as long as you accomplish that, it works. For arms or hips, you have to worry about other things\u2014you have articulating joints and many forces involved.\u201d \u201cIt hasn\u2019t been easy\u2014starting a company is difficult, and it\u2019s even more difficult to start a company in Mexico, and even more difficult to start a company in the health sector in Mexico.\u201d It took Carlos and his business partners more than two years to gain the necessary permits and approvals from the Mexican government. Granta was the first-ever Mexican company\u2014and one of just six or seven companies in the world\u2014 to design custom skull implants. Right as they were opening their doors, they received a call from a local doctor and just like that, they had their first patient. <strong>Coming to Adriana\u2019s Aid<\/strong> Adriana\u2019s case was a tricky one. She had been a happy and healthy woman living in Mexico City with her husband, Jesus, before she suffered an aneurysm that put her in a life-threatening condition. After surgery to repair the injury failed, doctors told her and her family that they would need to perform a craniotomy (a procedure to remove part of her skull) in order for her brain to decompress, and to save her life. Today there are four primary ways to do a skull implant, or cranioplasty, to replace the bone removed during a craniotomy. The most common method is poly methyl melacrylate (PMMA) implants, which are molded during surgery to the patient\u2019s cranium. Unfortunately, these implants are susceptible to bacterial growth and water absorption, which can result in infection. Another option is titanium meshes, which are expensive, fragile and difficult to work with\u2014meaning they can often look flat or unnatural on the patient\u2019s skull. They\u2019re also prone to further bending or even becoming exposed through the skin, which requires additional surgery to repair or remove the damaged areas of the implant. There\u2019s also grafting options, which involve harvesting bone from either the patient\u2019s own body\u2014a painful and lengthy process\u2014 or from a cadaver, which has a high risk of being rejected by the patient\u2019s body. The final option\u2014sometimes called a decompressive craniectomy\u2014is often considered a last resort. To allow the brain to decompress after trauma or injury, a part of the skull is removed and then surgically implanted into the patient\u2019s abdomen to keep the skull tissue alive. Once swelling in the brain goes down\u2014which can take up to 20 weeks\u2014the piece of skull is then taken out of the stomach and re-implanted. Unfortunately, the skull tissue often dies before the final transplant can be performed, making this a high-risk option. With Granta, Carlos knew that he could provide a fifth option that would be safer, easier to install surgically, and more natural-looking for the patient. But he also knew that choosing the right set of tools to design, prototype, engineer and manufacture the implants was critical. That\u2019s when he reached out to the <a href=\"https:\/\/autode.sk\/2Iv1U9G\">Autodesk Foundation<\/a>. They helped Carlos and his team to find the right solutions and got them trained them up on the software. Adriana\u2019s initial cranioplasty was performed using a PMMA implant. She seemed to be recovering well before a secondary infection occurred, which led to a buildup of fluid under the implant that damaged it to the point that emergency surgery was performed to remove it. Once again, Adriana found herself in a precarious state, and it wasn\u2019t just affecting her physical health. It took a huge emotional toll on her and her family. She did not feel, or look, like the woman that she once was. It&#8217;s a common hardship for people who suffer trauma to the skull. Their self-esteem is impacted by their changed appearance, making it difficult to lead a regular life, or even keep their job. Adriana\u2019s family was becoming more and more concerned, and by the time they were put in touch with Carlos, the situation was serious. <div id=\"attachment_5247\" style=\"width: 1929px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5247\" class=\"wp-image-5247 size-full\" src=\"https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/04\/Adriana-Netfabb-2.png\" alt=\"\" width=\"1919\" height=\"1035\" srcset=\"https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/04\/Adriana-Netfabb-2.png 1919w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/04\/Adriana-Netfabb-2-300x162.png 300w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/04\/Adriana-Netfabb-2-1024x552.png 1024w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/04\/Adriana-Netfabb-2-700x378.png 700w\" sizes=\"auto, (max-width: 1919px) 100vw, 1919px\" \/><p id=\"caption-attachment-5247\" class=\"wp-caption-text\">A digital model of Adriana&#8217;s skull in Autodesk Netfabb.<\/p><\/div> <div id=\"attachment_4961\" style=\"width: 1034px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4961\" class=\"wp-image-4961 size-large\" src=\"https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/netfabb-3-1024x554-1024x554.png\" alt=\"\" width=\"1024\" height=\"554\" srcset=\"https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/netfabb-3-1024x554.png 1024w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/netfabb-3-1024x554-300x162.png 300w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/netfabb-3-1024x554-700x379.png 700w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><p id=\"caption-attachment-4961\" class=\"wp-caption-text\">The implant was designed to fit perfectly into the affected area of Adriana&#8217;s skull.<\/p><\/div> <strong>Customized with Care (and CAD)<\/strong> After receiving Adriana\u2019s case, Carlos and his team immediately got to work. They had a full suite of Autodesk software at their disposal and made good use of it. After receiving a CT scan from her doctor they converted it to point cloud data and used <a href=\"https:\/\/autode.sk\/2G9huoU\">Autodesk Netfabb<\/a> to clean and prepare the file before bringing it into design software like <a href=\"https:\/\/autode.sk\/2IgaVV2\">Autodesk Inventor<\/a> or <a href=\"https:\/\/autode.sk\/2v3u5EI\">Fusion 360<\/a>. <\/p>\n<blockquote><p>It took only four minutes\u2014something the operating team had never before experienced.<\/p><\/blockquote>\n<p> Using this geometry, they designed a custom implant that would fit to the exact size and shape of Adriana\u2019s skull. They shared the digital file and a 3D printed prototype with the surgeon, who then provided feedback about any modifications that needed to be made. Once the design was finalized, the team manufactured the implant out of PEEK (polyethyl ethyl ketone), a polymer that\u2019s more biocompatible and less prone to infection\u2014a much safer option than traditional acrylic implants. To do this, Granta used <a href=\"https:\/\/autode.sk\/2Z5oWKc\">Autodesk Powermill<\/a> to machine the PEEK with a 5-axis CNC to match the 3D model. Since the implant needs to be a perfect replica of the design, the team 3D scanned it with <a href=\"https:\/\/autode.sk\/2UyaHir\">Autodesk ReCap<\/a>, which creates a virtual model of the physical part that they can then compare to the original 3D design. Everything matched up, so in September of 2018 the implant was then shipped to the hospital to be prepared for Adriana\u2019s surgery. <img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4958 size-full\" src=\"https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/IMG_3385-768x576.jpg\" alt=\"\" width=\"768\" height=\"576\" srcset=\"https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/IMG_3385-768x576.jpg 768w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/IMG_3385-768x576-300x225.jpg 300w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/IMG_3385-768x576-700x525.jpg 700w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/> Adriana&#8217;s implant is machined out of polyethyl ethyl ketone (PEEK) using a 5-axis CNC machine.A traditional cranioplasty can take upward of six hours to perform because the neurosurgeon has to spend a significant amount of time molding and shaping the implant\u2014whether it\u2019s made from acrylic, titanium or bone graft\u2014to fit the patient\u2019s skull. Time savings is a crucial factor because during the procedure the patient\u2019s tissue is exposed to possible contaminants in the environment. With Granta\u2019s implant, the surgeon was able to easily (and carefully) place it onto Adriana\u2019s skull for a perfect fit. It took only four minutes\u2014something the operating team had never before experienced. \u201cAt that point everything became so real,\u201d Carlos recounts. \u201cBeing able to see the implant being fit, being fixed to her skull in less than four minutes, and perfectly without any complications, and they closed it, and when we went out from the surgery room I couldn&#8217;t believe it. Everything made sense.\u201d The next day, Carlos went to meet Adriana in recovery. \u201cShe received me with a huge smile, and said, \u2018Thank you for what you have done for me, you have changed my life.\u2019 And in reality, it&#8217;s the other way around. I mean the way she changed my life is something that I will always be grateful to her for.\u201d <div id=\"attachment_4964\" style=\"width: 1034px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4964\" class=\"size-large wp-image-4964\" src=\"https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/Adriana-recovery-1024x575.png\" alt=\"\" width=\"1024\" height=\"575\" srcset=\"https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/Adriana-recovery-1024x575.png 1024w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/Adriana-recovery-300x168.png 300w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/Adriana-recovery-700x393.png 700w, https:\/\/adsknews.autodesk.com\/app\/uploads\/2019\/03\/Adriana-recovery.png 1170w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><p id=\"caption-attachment-4964\" class=\"wp-caption-text\">After her surgery, Adriana (left) started to feel like herself again.<\/p><\/div> <strong>Post-op Optimism<\/strong> Adriana\u2019s neurosurgeon, Dr. Pedro Pablo de Juambelz, was also delighted with the results. \u201cWhen we placed the implant during surgery, it fit her like a glove. It was very good,\u201d he explains. \u201cWe are really satisfied with the results and with the technical part of the placement. It helped us a lot to have the custom implant because she had a very large defect. The plate that had been previously placed looked unnatural and, despite our efforts to make it look aesthetic,she was left with a very deformed skull. When patients look in the mirror and don\u2019t look so deformed or so aesthetically affected, it helps them a lot in their emotional recovery and their functional operation.\u201d Dr. de Juambelz is optimistic about using more custom implants for future patients. \u201cAdriana\u2019s case has filled us with satisfaction, and I think our first choice is to continue using this type of implant in patients who have lost a bone fragment due to any reason, whether in surgery or any other reason. The hospital and our patients will benefit from being at the forefront of the technology.\u201d Since Adriana\u2019s surgery, Carlos and his team have gone on to help more patients. Four more people have already received custom implants, and several other cases are in development. \u201cWe began with implants for skulls, but now we\u2019re looking at what&#8217;s next, what else can we do with this technology, that allow us to help other people,\u201d Carlos explains. \u201cIt\u2019s not only that we make implants, we want to change people&#8217;s life and improve their quality of how they live.\u201d Every year there are thousands of surgeries in Mexico that could benefit from a custom implant. For Carlos, that means thousands of chances for him to fulfill his childhood dream of helping people.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dr. Monroy uses digital fabrication and advanced manufacturing to develop custom skull implants.<\/p>\n","protected":false},"author":6,"featured_media":4963,"template":"","categories":[19,10,8],"adsk_tags":[],"class_list":["post-4956","stories","type-stories","status-publish","has-post-thumbnail","hentry","categories-autodesk_foundation","categories-product_development","categories-product_design_and_manufacturing"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.3 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Granta\u2019s Custom Skull Implants Are Designed and Made in Mexico, With Love | Autodesk News<\/title>\n<meta name=\"description\" content=\"Dr. Monroy uses digital fabrication and advanced manufacturing to develop custom skull implants for 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