Fronto-naso-orbital Reconstructions

Acceptable durability of split inner table graft for the reconstruction of a bone defect in pterional craniotomies: a case series

Objective

During a pterional craniotomy, the bone defect was reconstructed by a surgical technique using an autogenous bone graft instead of commercially available alloplastic materials. The technical feasibility, durability of the grafted bone, and cosmetic outcome were all evaluated.

Methods

After a pterional craniotomy was performed, the bone defect at the frontobasal burr hole and drilled sphenoid wing was reconstructed using an autogenous split inner table graft (1 cm × 2 cm) harvested from the craniotomy bone flap.

Results

The bone reconstruction technique was successfully performed on nine patients with intracranial aneurysms. After 12-19 months from the surgery, a volumetry study using three-dimensional skull images reconstructed from computed tomography angiography showed a minimal decrease in the area of the split inner table graft due to bone resorption in six patients, which ranged from 5.7% to 14.8%. In the other three patients, the bone resorption was more substantial, ranging from 21.2% to 27.5%. However, in the three latter cases, the resorption was mainly limited to the posterior part of the split inner table graft covered by the temporalis muscle and did not affect the cosmetic outcomes. The resultant cosmetic outcomes for the nine patients were all favorable, with only a slight or no anterior temporal hollow.

Conclusion

The proposed surgical technique using a split inner table graft harvested from the craniotomy bone flap seems viable for reconstructing the bone defect at the frontobasal burr hole and drilled sphenoid wing after a pterional craniotomy.

Case Report: Simultaneous Resection of Bone Tumor and CAD/CAM Titanium Cranioplasty in Fronto-Orbital Region

Background: Simultaneous resection of bone tumors in the fronto-naso-orbital region is a great challenge due to the need for adequate reconstruction of the facial skeleton. Pre-operative virtual planning of resection margins and the simultaneous fabrication of the cranioplasty using computer-aided design/computer-aided manufacturing (CAD/CAM) technology could allow combining the tumor resection and cosmetic restoration steps into a single procedure.

Methods: We present five consecutive cases of patients with bone tumors of the fronto-naso-orbital region. The indications for surgery included: (1) the presence of a major cosmetic defect; (2) progressive tumor growth. The histological examination revealed vascular malformation, hemangioma, and fibrous dysplasia in two cases. Tumor resection was performed with the help of a drilling template in form of a tumor. The computer-designed cranioplasty formed based on the non-involved side of the skull of the patient was manufactured. In one patient, the reconstruction was performed using two separate implants.

Results: The position of the implant fits in with pre-operative planning in two cases; in those cases, the additional trimming of the implant or bone defect was required. Good cosmetic outcomes were noted in all patients, and no complications occurred. No repeat surgery was necessary. The template has proved to have high application potential.

Conclusion: Simultaneous resection and CAD/CAM cranioplasty in the case of bone tumors in the fronto-orbital region is a promising technique with the aim of minimizing operation time and achieving a good esthetic outcome.

Reconstruction for diverse fronto-orbital defects with computer-assisted designed and computer-assisted manufactured PEEK implants in one-stage operation: Case reports

RATIONAL

Reconstruction of complex craniofacial defects in fronto-orbital region has been reported to be extremely few. In this study, we report 2 cases with fronto-orbital defects of different etiologies in one-stage surgical reconstruction with polyetheretherketone (PEEK) prosthesis using computer-assisted design and computer-assisted manufactured (CAD-CAM) techniques.

PATIENT CONCERNS

One patient was a 49-year-old man, who admitted with a depressed and comminuted fracture in the left fronto-orbital region as a result of a motor vehicle collision. The other patient was a 45-year-old woman who was hospitalized with an unexpected diagnosis of a fronto-orbital bone tumor during a head CT examination in a minor traumatic brain injury. None of them had a significant past medical history.

DIAGNOSES

The first patient's head computed tomography (CT) showed multiple depressed comminuted fractures in the right fronto-orbital region with localized frontal lobe contusion, and the diagnosis was clear when combined with the mechanism of traumatic head injuries. The second patient's head CT and magnetic resonance image suggested a right lateral orbital neoplastic lesion that distorted peripheral bone, the postoperative pathological examination demonstrated an osteoma with fibromatous hyperplasia, and thus the women's diagnosis was confirmed.

INTERVENTIONS

A three-dimensional image of both patients' skull bone were collected from a high-resolution CT. A virtual surgical planning for lesion excision and defect remodeling based on CAD-CAM techniques was undertaken, and than the reconstruction surgery was performed in a single procedure using PEEK prosthesis. Antibacterial treatment was prescribed routinely.

OUTCOMES

Postoperatively, both patients achieved excellent aesthetic restoration as well as functional recovery of the orbital cavity without neurological or infectious complications during an average 22 months follow-up.

LESSONS

The CAD-CAM PEEK implants could be a preferred option for reconstruction of patients with various complex fronto-orbital defects.