A Carolus1, S Weihe2,3, K Schmieder4, C Brenke4. 1. Department of Neurosurgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-35, 44892, Bochum, Germany. anneelisabeth.carolus@kk-bochum.de. 2. Department of Maxillofacial and Craniofacial Surgery, Klinikum Dortmund, Dortmund, Germany. 3. IMDI - Institute for Medical and Dental Innovations, Associated Institute oft the University Witten/Herdecke, Witten, Germany. 4. Department of Neurosurgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-35, 44892, Bochum, Germany.
Abstract
INTRODUCTION: Cranial defects following intra-osseous tumor removal may be large and require adequate reconstruction. CAD/CAM implants have been used for years to achieve an optimal cosmetic result. The disadvantage is that such implants require a second surgery. A preoperative virtual planning of resection margins and the simultaneously fabrication of the cranioplasty could be a possibility to subsume the steps tumor resection and cosmetic restoration to a single procedure. METHODS: We present two cases of patients with complex intra-osseous spheno-orbital meningioma. Tumor resection was performed with the help of a drilling template in form of a frame. The template also served as a negative for the computer-designed cranioplasty. The devices were manufactured by DMD GmbH - Digital Medical Design/DDI-Group, Dortmund, Germany. DISCUSSION: The usage of the template was highly practicable. Small adjustments in bone removal were necessary to achieve an optimal fitting of the implant. The 6-month follow-up showed for one patient a good and for one a satisfactory cosmetic result. No second surgery was necessary. CONCLUSIONS: Drilling template application could contribute to challenging cases of large fronto-basal meningiomas with the aim of minimizing operation time and achieving a good esthetic outcome.
INTRODUCTION: Cranial defects following intra-osseous tumor removal may be large and require adequate reconstruction. CAD/CAM implants have been used for years to achieve an optimal cosmetic result. The disadvantage is that such implants require a second surgery. A preoperative virtual planning of resection margins and the simultaneously fabrication of the cranioplasty could be a possibility to subsume the steps tumor resection and cosmetic restoration to a single procedure. METHODS: We present two cases of patients with complex intra-osseous spheno-orbital meningioma. Tumor resection was performed with the help of a drilling template in form of a frame. The template also served as a negative for the computer-designed cranioplasty. The devices were manufactured by DMD GmbH - Digital Medical Design/DDI-Group, Dortmund, Germany. DISCUSSION: The usage of the template was highly practicable. Small adjustments in bone removal were necessary to achieve an optimal fitting of the implant. The 6-month follow-up showed for one patient a good and for one a satisfactory cosmetic result. No second surgery was necessary. CONCLUSIONS: Drilling template application could contribute to challenging cases of large fronto-basal meningiomas with the aim of minimizing operation time and achieving a good esthetic outcome.
Entities:
Keywords:
CAD/CAM; Cosmetic outcome; Drilling template; Single-step resection and reconstruction; Skull base meningiomas; Titanium cranioplasty
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