J Neurol Surg B
DOI: 10.1055/s-0039-1681044
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Single-Step Resection of Sphenoorbital Meningiomas and Orbital Reconstruction Using Customized CAD/CAM Implants

Lukas Goertz
1  Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
,
Pantelis Stavrinou
1  Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
,
George Stranjalis
2  Department of Neurosurgery, University of Athens, Evangelismos Hospital, Athens, Greece
,
Marco Timmer
1  Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
,
Roland Goldbrunner
1  Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
,
Boris Krischek
1  Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
› Author Affiliations
Further Information

Publication History

27 September 2018

27 January 2019

Publication Date:
01 March 2019 (online)

Abstract

Objective Computer-aided design and manufacturing (CAD/CAM) implants are fabricated based on volumetric analysis of computed tomography (CT) scans and are routinely used for the reconstruction of orbital fractures. We present three cases of patients with sphenoorbital meningiomas that underwent tumor resection, orbital decompression, and orbital reconstruction with patient specific porous titanium or acrylic implants in a single procedure.

Methods The extent of bone resection of the sphenoorbital meningiomas was planned in a virtual three-dimensional (3D) environment using preoperative thin-layer CT data. The anatomy of the orbital wall in the resection area was reconstructed by superimposing the contralateral unaffected orbit and by using the information of the neighboring bony structures. The customized implants and a corresponding craniotomy template were designed in the desired size and shape by the manufacturer.

Results All patients presented with a sphenoorbital meningioma and exophthalmos. After osteoclastic craniotomy with the drilling template, orbital decompression was performed. Implant fitting was tight in two cases and could be easily fixated with miniplates and screws. In the third patient, a reoperation was necessary for additional bone resection, as well as drilling and repositioning of the implant. The postoperative CT scans showed an accurate reconstruction of the orbital wall. After surgery, exophthalmos was substantially reduced and a satisfying cosmetic result could be finally achieved in all patients.

Conclusions The concept of preoperative 3D virtual treatment planning and single-step orbital reconstruction with CAD/CAM implants after tumor resection involving the orbit is well feasible and can lead to good cosmetic results.