Carolus A, Weihe S, Schmieder K, Brenke C
Department of Neurosurgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-35, 44892, Bochum, Germany.
Department of Maxillofacial and Craniofacial Surgery, Klinikum Dortmund, Dortmund, Germany.
Acta Neurochir (Wien). 2017 Mar;159(3):447-452. doi: 10.1007/s00701-016-3053-4. Epub 2017 Jan 10.
Cranial defects following intra-osseous tumor removal may be large and require adequate reconstruction. CAD/CAM implants have been used for years to achieve an optimal cosmetic result. The disadvantage is that such implants require a second surgery. A preoperative virtual planning of resection margins and the simultaneously fabrication of the cranioplasty could be a possibility to subsume the steps tumor resection and cosmetic restoration to a single procedure.
We present two cases of patients with complex intra-osseous spheno-orbital meningioma. Tumor resection was performed with the help of a drilling template in form of a frame. The template also served as a negative for the computer-designed cranioplasty. The devices were manufactured by DMD GmbH - Digital Medical Design/DDI-Group, Dortmund, Germany.
The usage of the template was highly practicable. Small adjustments in bone removal were necessary to achieve an optimal fitting of the implant. The 6-month follow-up showed for one patient a good and for one a satisfactory cosmetic result. No second surgery was necessary.
Drilling template application could contribute to challenging cases of large fronto-basal meningiomas with the aim of minimizing operation time and achieving a good esthetic outcome.
骨内肿瘤切除术后的颅骨缺损可能较大，需要进行充分的重建。多年来，计算机辅助设计/计算机辅助制造（CAD/CAM）植入物一直被用于实现最佳的美容效果。缺点是这种植入物需要二次手术。术前对切除边缘进行虚拟规划并同时制作颅骨成形术可能是将肿瘤切除和美容修复步骤合并为一个程序的一种方法。
我们展示了两例复杂的骨内蝶眶脑膜瘤患者。在一个框架形式的钻孔模板的帮助下进行肿瘤切除。该模板还用作计算机设计的颅骨成形术的阴模。这些装置由德国多特蒙德的DMD GmbH - 数字医疗设计/DDI集团制造。
模板的使用非常实用。为了使植入物达到最佳贴合，需要对骨切除进行小的调整。6个月的随访显示，一名患者的美容效果良好，另一名患者的美容效果令人满意。无需进行二次手术。
应用钻孔模板有助于处理大型额底部脑膜瘤的复杂病例，目的是尽量缩短手术时间并取得良好的美学效果。
