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Gadzhiagaev VS, Lasunin NV, Okishev DN, Konovalov AN, Golbin DA, Cherekaev VA, Serova NK, Grigorieva NN. One-step orbit reconstruction using PMMA implants following hyperostotic sphenoid wing meningioma removal: Evolution of the technique in short clinical series. World Neurosurg X 2024; 22:100281. [PMID: 38455245 PMCID: PMC10918255 DOI: 10.1016/j.wnsx.2024.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose To report our experience with patient specific implants for one-step orbit reconstruction following hyperostotic SWM removal and to describe the evolution of the technique through three surgical cases. Methods: Three cases of one-step SWM removal and orbit reconstruction are described. All cases are given consecutively to describe the evolution of the technique. Hyperostotic bone resection was facilitated by electromagnetic navigation and cutting guides (templates). Based on a 3D model, silicone molds were made using CAD/CAM. Then PMMA implant was fabricated from these molds. The implant was adjusted and fixed to the cranium with titanium screws after tumor removal. Results: Following steps of the procedure changed over these series: hyperostotic bone resection, implant thickness control, implant overlay features, anatomic adjustments, implant fixation. The proptosis resolved in all cases. In one patient the progressive visual acuity deterioration was recognized during the follow-up. No oculomotor disturbances and no tumor regrowth were found at the follow-up. Conclusion CAD/CAM technologies enable creation of implants of any size and configuration, and thereby, to increase the extent of bony resection and lower the risk of tumor progression. The procedure is performed in one step which decreases the risk of postoperative morbidity.
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Affiliation(s)
- Vadim S. Gadzhiagaev
- Burdenko Neurosurgical Center, Department of Cerebrovascular Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Nikolay V. Lasunin
- Burdenko Neurosurgical Center, Department of Cranio-Facial Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Dmitriy N. Okishev
- Burdenko Neurosurgical Center, Department of Cerebrovascular Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Anton N. Konovalov
- Burdenko Neurosurgical Center, Department of Cerebrovascular Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Denis A. Golbin
- Burdenko Neurosurgical Center, Department of Cranio-Facial Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Vasily A. Cherekaev
- Burdenko Neurosurgical Center, Department of Cranio-Facial Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Natalia K. Serova
- Burdenko Neurosurgical Center, Department of Neuro-ophthalmology, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Nadezhda N. Grigorieva
- Burdenko Neurosurgical Center, Department of Neuro-ophthalmology, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
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So J, Lee H, Jeong J, Forterre F, Roh Y. Endoscopy-assisted resection of a sphenoid-wing meningioma using a 3D-printed patient-specific pointer in a dog: A case report. Front Vet Sci 2022; 9:979290. [DOI: 10.3389/fvets.2022.979290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022] Open
Abstract
A 9-year-old female mixed-breed dog presented for treatment of a presumed sphenoid-wing meningioma. Clinical signs included tonic-clonic seizures lasting <1 min, which had started 3 months previously. The physical examination results were unremarkable. An eccentrically located neoplastic cystic structure in the right sphenoid bone region suggestive of a meningioma and peritumoural brain oedema was observed in pre-operative magnetic resonance imaging (MRI). Prior to surgery, a three-dimensional (3D) patient-specific pointer (PSP) was designed using computed tomography (CT) images and computer-aided 3D design software. After a targeted approach and exposure of the lateral part of the right temporal lobe by a craniectomy guided by the 3D-PSP, complete macroscopic piecemeal resection of the meningioma could be performed using endoscopy-assisted brain surgery. Post-operative MRI confirmed complete excision of the tumor. Anticonvulsive therapy was discontinued after 90 days, and the dosage of anticonvulsants was tapered 2 weeks after surgery. At a follow-up examination 225 days post-operatively, recurrence of seizures was not observed, and the absence of tumor recurrence was confirmed by a repeat MRI examination. To the best of our knowledge, this is the first report in veterinary medicine describing a successful resection of a sphenoid-wing meningioma using a 3D-PSP. 3D-PSP-assisted craniectomy may be a surgical option for some canine skull-based tumors, such as sphenoid wing meningiomas.
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Steiert C, Behringer SP, Kraus LM, Bissolo M, Demerath T, Beck J, Grauvogel J, Reinacher PC. Augmented reality-assisted craniofacial reconstruction in skull base lesions - an innovative technique for single-step resection and cranioplasty in neurosurgery. Neurosurg Rev 2022; 45:2745-2755. [PMID: 35441994 PMCID: PMC9349131 DOI: 10.1007/s10143-022-01784-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/19/2022] [Accepted: 03/30/2022] [Indexed: 10/31/2022]
Abstract
Defects of the cranial vault often require cosmetic reconstruction with patient-specific implants, particularly in cases of craniofacial involvement. However, fabrication takes time and is expensive; therefore, efforts must be made to develop more rapidly available and more cost-effective alternatives. The current study investigated the feasibility of an augmented reality (AR)-assisted single-step procedure for repairing bony defects involving the facial skeleton and the skull base. In an experimental setting, nine neurosurgeons fabricated AR-assisted and conventionally shaped ("freehand") implants from polymethylmethacrylate (PMMA) on a skull model with a craniofacial bony defect. Deviations of the surface profile in comparison with the original model were quantified by means of volumetry, and the cosmetic results were evaluated using a multicomponent scoring system, each by two blinded neurosurgeons. Handling the AR equipment proved to be quite comfortable. The median volume deviating from the surface profile of the original model was low in the AR-assisted implants (6.40 cm3) and significantly reduced in comparison with the conventionally shaped implants (13.48 cm3). The cosmetic appearance of the AR-assisted implants was rated as very good (median 25.00 out of 30 points) and significantly improved in comparison with the conventionally shaped implants (median 14.75 out of 30 points). Our experiments showed outstanding results regarding the possibilities of AR-assisted procedures for single-step reconstruction of craniofacial defects. Although patient-specific implants still represent the gold standard in esthetic aspects, AR-assisted procedures hold high potential for an immediately and widely available, cost-effective alternative providing excellent cosmetic outcomes.
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Affiliation(s)
- Christine Steiert
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Simon Phillipp Behringer
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Luisa Mona Kraus
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Bissolo
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Grauvogel
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Christoph Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Fraunhofer Institute for Laser Technology, Aachen, Germany
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Wang Z, Liang X, Yang Y, Gao B, Wang L, You W, Chen Z, Wang Z. A new scoring system for predicting extent of resection in medial sphenoid wing meningiomas based on three-dimensional multimodality fusion imaging. Chin Neurosurg J 2020; 6:35. [PMID: 33292782 PMCID: PMC7604967 DOI: 10.1186/s41016-020-00214-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) fusion imaging has been proved to be a promising neurosurgical tool for presurgical evaluation of tumor removal. We aim to develop a scoring system based on this new tool to predict the resection grade of medial sphenoid wing meningiomas (mSWM) intuitively. METHODS We included 46 patients treated for mSWM from 2014 to 2019 to evaluate their tumors' location, volume, cavernous sinus involvement, vascular encasement, and bone invasion by 3D multimodality fusion imaging. A scoring system based on the significant parameters detected by statistical analysis was created and evaluated. RESULTS The tumor volumes ranged from 0.8 cm3 to 171.9 cm3. A total of 39 (84.8%) patients had arterial involvement. Cavernous sinus (CS) involvement was observed in 23 patients (50.0%) and bone invasion was noted in 10 patients (21.7%). Simpson I resection was achieved in 10 patients (21.7%) and Simpson II resection was achieved in 17 patients (37.0%). Fifteen patients (32.6%) underwent Simpson III resection and 4 patients (8.7%) underwent Simpson IV resections. A scoring system was created. The score ranged from 1 to 10 and the mean score of our patients was 5.3 ± 2.8. Strong positive monotonic correlation existed between the score and resection grade (Rs = 0.772, P < 0.001). The scoring system had good predictive capacity with an accuracy of 69.60%. CONCLUSIONS We described a scoring system that enabled neurosurgeons to predict extent of resection and outcomes for mSWM preoperatively with 3D multimodality fusion imaging. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Zilan Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xiaolong Liang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu Province, China
| | - Yanbo Yang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Bixi Gao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Ling Wang
- Department of Radiology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, 215006, Jiangsu Province, China
| | - Wanchun You
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Zhouqing Chen
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Zhong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
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Transclival approaches for intradural pathologies: historical overview and present scenario. Neurosurg Rev 2020; 44:279-287. [PMID: 32060761 DOI: 10.1007/s10143-020-01263-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/29/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022]
Abstract
Recently, endoscopic transsphenoidal transclival approaches have been developed and their role is widely accepted for extradural pathologies. Their application to intradural pathologies is still debated, but is undoubtedly increasing. In the past five decades, different authors have reported various extracranial, anterior transclival approaches for intradural pathologies. The aim of this review is to provide a historical overview of transclival approaches applied to intradural pathologies. PubMed was searched in October 2018 using the terms transcliv*, cliv* intradural, transsphenoidal transcliv*, transoral transcliv*, transcervical transcliv*, transsphenoidal brainstem, and transoral brainstem. Exclusion criteria included not reporting reconstruction technique, anatomical studies, reviews without new data, and transcranial approaches. Ninety-one studies were included in the systematic review. Since 1966, transcervical, transoral, transsphenoidal microsurgical, and, recently, endoscopic routes have been used as a corridor for transclival approaches to treat intradural pathologies. Each approach presents a curve that follows Scott's parabola, with evident phases of enthusiasm that quickly faded, possibly due to high post-operative CSF leak rates and other complications. It is evident that the introduction of the endoscope has led to a significant increase in reports of transclival approaches for intradural pathologies. Various reconstruction techniques and materials have been used, although rates of CSF leak remain relatively high. Transclival approaches for intradural pathologies have a long history. We are now in a new era of interest, but achieving effective dural and skull base reconstruction must still be definitively addressed, possibly with the use of newly available technologies.
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Bianchi F, Signorelli F, Di Bonaventura R, Trevisi G, Pompucci A. One-stage frame-guided resection and reconstruction with PEEK custom-made prostheses for predominantly intraosseous meningiomas: technical notes and a case series. Neurosurg Rev 2019; 42:769-775. [DOI: 10.1007/s10143-019-01104-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 10/26/2022]
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Ivan ME, Cheng JS, Kaur G, Sughrue ME, Clark A, Kane AJ, Aranda D, McDermott M, Barani IJ, Parsa AT. Association of morbidity with extent of resection and cavernous sinus invasion in sphenoid wing meningiomas. J Neurol Surg B Skull Base 2013; 73:76-83. [PMID: 23372999 DOI: 10.1055/s-0032-1304562] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 09/06/2011] [Indexed: 12/15/2022] Open
Abstract
Sphenoid wing meningiomas (SWMs) typically are histologically benign, insidious lesions, but the propensity of these tumors for local invasion makes disease control very challenging. In this review, we assess whether the degree of resection and extent of cavernous sinus invasion affects morbidity, mortality, and recurrence in patients with SWM. A comprehensive search of the English-language literature was performed. Patients were stratified according to extent of resection and extent of cavernous sinus invasion, and tumor recurrence rate, morbidity, and mortality were analyzed. A total of 23 studies and 131 patients were included. Overall recurrence and surgical mortality rate were 11% and 2%, respectively (average follow-up = 65 months). Cranial nerve III palsy was significantly associated with incompletely versus completely resected SWMs (7 to 0%) as well as meningiomas with cavernous sinus invasion versus no sinus invasion (14 vs. 0%). No significant difference in tumor recurrence rate was noted between these groups. In conclusion, complete excision of SWMs is always recommended whenever possible, but surgeons should acknowledge that there is nonetheless a chance of recurrence and should weigh this against the risk of causing cranial nerve injuries.
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Affiliation(s)
- Michael E Ivan
- Department of Neurological Surgery, University of California, San Francisco, California
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Markiewicz MR, Dierks EJ, Bell RB. Does intraoperative navigation restore orbital dimensions in traumatic and post-ablative defects? J Craniomaxillofac Surg 2012; 40:142-8. [DOI: 10.1016/j.jcms.2011.03.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 12/29/2010] [Accepted: 03/01/2011] [Indexed: 11/16/2022] Open
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Luetjens G, Krauss JK, Brandis A, Nakamura M. Bilateral sphenoorbital hyperostotic meningiomas with proptosis and visual impairment: A therapeutic challenge. Report of three patients and review of the literature. Clin Neurol Neurosurg 2011; 113:859-63. [DOI: 10.1016/j.clineuro.2011.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 06/01/2011] [Accepted: 06/19/2011] [Indexed: 11/26/2022]
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Markiewicz MR, Dierks EJ, Potter BE, Bell RB. Reliability of Intraoperative Navigation in Restoring Normal Orbital Dimensions. J Oral Maxillofac Surg 2011; 69:2833-40. [DOI: 10.1016/j.joms.2010.12.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 11/21/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022]
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Abstract
This report details a technique for spheno-orbital reconstruction after meningioma resection. The approach uses a life-size skull model generated from a thin-slice craniomaxillofacial computed tomogram. On this skull model, the planned area of bone removal of the involved orbit and sphenoid is outlined on the normal side opposite the lesion. A three-dimensional implant is then generated by reversing the anticipated area of bone resection on the normal side to create a mirror-image implant. This technique resulted in minimal intraoperative implant contouring, decreased surgical time, and satisfactory functional and cosmetic outcome.
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Affiliation(s)
- Michael B Pritz
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Zenha H, Azevedo L, Rios L, Pinto A, Luz Barroso M, Cunha C, Costa H. The application of 3-D biomodeling technology in complex mandibular reconstruction—experience of 47 clinical cases. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0503-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Surgical navigation for meningioma surgery. J Neurooncol 2010; 99:357-64. [DOI: 10.1007/s11060-010-0359-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/09/2010] [Indexed: 10/19/2022]
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