gms | German Medical Science

Objective: Resection of bone infiltrating meningeomas of the sphenoid plane, involving the orbital walls, is a highly challenging neurosurgical procedure. Complete tumour resection, cranial reconstruction as well as cosmetic satisfaction are key points that need to be considered and fulfilled to the highest standard. Incomplete resection often leads to growth recurrence, repeating surgical procedures or radiation therapy. Reconstruction of the bony defect has seen the use of different techniques such as polymethylmethacryl bone cement or titanium meshes, but often a thorough dedication of the surgeon in order to achieve the aforementioned goals is required.

In this study, we performed 10 resections of meningeomas of the middle fossa using a pre-designed CAD PMMA-implant with simultaneous osseous reconstruction.

Methods: In all 10 cases, CT scans were performed and evaluated, in order to produce a customised PMMA-implant, fitting the osseous defect left after surgical resection of the predefined tumour mass. Intraoperative surgical aides consist of preplanned neuro-navigational data as well as a matching template for intraoperative use.

Results: In 60%, gross total tumour resection was achieved, 20% of patients with a small residual tumour mass required no further surgery, one patient needed secondary surgery. Another patient required removal oft he implant due to a surgical site infection. All of the cases showed satisfying cosmetic results. 80% of the patients demonstrated an exopthalmus prior to surgery, with a good reduction postoperatively. 30% showed slight atrophy of the m. temporalis.

Conclusion: Our experience with CAD-implants combined with planned resections show that gross total resection of osseous meningeomas of the sphenoid plane involving the orbital walls can be achieved using the intraoperative neuronavigation data and template, all while leaving a satisfying cosmetic result in one surgical procedure.