Synchronized “One-Step” Resection and Cranio-Orbital Reconstruction for Spheno-Orbital Lesions With Custom Made Implant

Abstract

Background: In the last few years, skull base tumors involving the fronto-orbital region have been approached with complex, invasive, and time-consuming cranial reconstruction techniques. On the other hand, recent custom-made implants allow easier and faster procedures, with excellent aesthetic results. The authors propose an easy surgical-planned protocol with a synchronized ''one-step'' resection and reconstruction of these complex lesions, with a preformed poly-methyilmethacrylate (PMMA) cranioplasty. Methods: Our technique consists of a 2-phases procedure. In the first one, the so-called ''virtual'' phase, the authors get a tailored 3D-PMMA model based on high-resolution (HR) CT-scans of the patient's skull. Afterward, the authors perform the planned craniotomy on the 3D-PMMA model with the assistance of intraoperative navigation system. Therefore, a further CT-scan of the resected model is performed to develop the final implant. In the second phase, the ''surgical phase,'' a single procedure consisting in a cranial resection and custom reconstruction is performed with the assistance of stealth-navigation. The authors describe 6 cases of complex fronto-orbital-sphenoidal benign tumors that required skull reconstruction. All patients were examined 3 months after surgery through cosmetic (facial and eyes symmetry and globe position) and ophthalmology tests (visual field, visual impairment, and diplopia). Postsurgical HR CT-scans of the head and MRI-scans of the brain documented a total resection of the tumor and an optimal accuracy of skull reconstruction. Results: In all cases, the authors obtained a highly accurate skull reconstruction following cranio-orbital tumor resection, with a less aggressive and faster procedure compared to autologous bone graft. Final cosmetic and functional results were excellent, with good results in cases of presurgical exophthalmos and orbital asymmetry. None of the patients developed implant-related complications. Conclusions: The ''one-step'' resection and reconstruction of benign tumors involving the spheno-orbital region with neuronavigation assistance is a technique that allows an accurate tumor removal and a cranial-bone reconstruction within a single surgical procedure, with fewer complications and excellent cosmetic and functional results.

Customized polymethylmethacrylate cranioplasty using a low-cost 3-dimensional printed mold

“…Besides excellent esthetic outcome, shorter operation time, lower blood loss and infection rate, without donor site morbidity, using printed customized molds offers the possibility of intraoperative correction and remanufacturing of the graft in case of infection or prosthesis fracture [9,14,15]. The total price of graft manufacturing is below 600$, making it lower than the prices stated in the literature, ranging 600-5000$.…”

State-of-Art of Standard and Innovative Materials Used in Cranioplasty

“…These 3D printing technologies are already used in clinical practice. One example is the one-step procedure that consists of a single surgical operation comprising a resection and reconstruction of cranial defects for lesions involving the skull base [71]. An example is reported in Figure 7: stable fixation in a short time.…”

“…These 3D printing technologies are already used in clinical practice. One example is the one-step procedure that consists of a single surgical operation comprising a resection and reconstruction of cranial defects for lesions involving the skull base [71]. An example is reported in Figure 7: This procedure takes advantage of virtual 3D skull modelling techniques (Phantom model) (Figure 7a) by acquiring the patient's high resolution (HR) CT-scan (Figure 7b) and creating a tailored cranioplasty, which reproduces an accurate reconstruction of the bone defect.…”

Endoscopic transorbital and transcranial multiportal resection of a sphenoorbital meningiomas with custom bone 3D printing reconstruction: Case report

“…Reconstruction of craniofacial defects can be carried out with autogenous tissue, allogenic implants, alloplastic material such as methacrylate, hidroxyapatite, titanium implants, and mesh system, each of them having some advantages and disadvantages 20 . In the ideal setting, tumor removal and bone defect covering occur in a “one‐step” surgery, avoiding the need of a second operative procedure: to do so, the craniotomy necessary for tumor removal and consequently the cranioplasty have to be accurately planned preoperatively 20–22 . Advancements in computer‐assisted planning and manufacturing have significantly influenced treatment options and expanded the range of possibilities of reconstruction with patient‐specific implants.…”