Department of Neurological Surgery, University of California, San Francisco California, USA.
Can J Neurol Sci. 2011 Jan;38(1):59-64. doi: 10.1017/s0317167100011082.
Hyperostosis of the bone overlying meningiomas has been reported in up to 50% of cases. The skull becomes infiltrated by meningothelial tumor cells, necessitating removal of the hypertrophied bone to achieve a complete tumor resection. Unfortunately, aesthetic reconstruction of large bony defects can pose a significant challenge intra-operatively. Custom cranioplasty implants are very expensive and can only be fabricated after the bony defect exists, requiring a second surgery for implantation. Although numerous composite materials exist to repair the defects at the time of tumor resection, the challenge is to create an implant that fits appropriately without shifting and approximates the natural curvature of the skull. We have developed a technique for an "in situ cranioplasty" using a composite construct with strength in compression and tension.
After the skull is reshaped by shaving down part of the hyperostotic bone, titanium mesh is molded to the surface of the skull and screwed into the surrounding normal bone. The bone flap is then removed by drilling a trough at the outer margin of the tumor-involved skull and removing a ring of normal surrounding bone. The central portion of tumor involved skull is then craniectomized. The mesh can be reapplied and the full thickness of the central bone can be reconstructed with polymethylmethacrylate, yielding a solid construct perfectly matched to the patient's natural head shape.
This novel technique yields a sturdy, aesthetic, and cost-effective result which can be used to address any cranial vault defect at the time of tumor resection.
高达 50%的脑膜瘤病例中存在骨过度生长。脑膜瘤细胞浸润颅骨，需要切除肥大的骨以实现肿瘤的完全切除。不幸的是，术中对大骨缺损进行美学重建是一个巨大的挑战。定制颅骨修补植入物非常昂贵，只能在骨缺损存在时制造，需要进行第二次手术植入。虽然有许多复合材料可以在肿瘤切除时修复这些缺陷，但挑战在于制造出一种合适的植入物，它不会移位，并与颅骨的自然曲率相匹配。我们已经开发出一种使用具有抗压和张力强度的复合材料构建体进行“原位颅骨成形术”的技术。
颅骨通过削除部分骨过度生长的部分进行重塑后，钛网被模塑到颅骨表面并用螺钉固定在周围正常的骨头上。然后通过在肿瘤受累颅骨的外边缘钻一条槽并去除正常周围骨的环形部分来去除骨瓣。然后对肿瘤受累颅骨的中央部分进行颅骨切除术。可以重新应用网格，并可以用聚甲基丙烯酸甲酯重建中央骨的全厚度，从而形成与患者自然头部形状完全匹配的坚固结构。
这种新颖的技术可获得坚固、美观且具有成本效益的结果，可在肿瘤切除时用于解决任何颅顶缺损。
