Luo Joseph, Morrison David Anthony, Hayes Alex John, Bala Arul, Watts Guy
Department of Plastic and Reconstructive Surgery, Sir Charles Gairdner Hospital, Nedlands.
Department of Medical Engineering and Physics, Royal Perth Hospital, Perth.
J Craniofac Surg. 2018 Jun;29(4):839-842. doi: 10.1097/SCS.0000000000004311.
Different methods have been described for the reconstruction of cranial defects and orbital defects. The complex contouring between the orbital roof and frontal bone creates significant design challenges for prefabricated cranio-orbital reconstructions. In describing the first reported patient of combined skull and orbital roof reconstruction with a single-piece titanium plate cranioplasty, the authors present a new method of combined complex cranio-orbital reconstruction.
A 63-year-old lady presented with a large, right-sided frontal en-plaque meningioma involving the right orbit and sphenoid wing. Complete resection would require reconstruction of both the skull and the orbital roof. Surgical preplanning involved marking resection margins on a three-dimensional (3D) printed acrylonitrile-butadiene-styrene model. This margin was used to virtually resect the tumor and generate a repaired surface. A titanium plate was then fabricated using hydrostatic pressing into a 3D-printed mold and the orbital roof portion (a reentrant surface) was hand-finished. Lateral canthus and temporalis muscle suspension holes were prefabricated into the cranioplasty plate.
The patient underwent hemicraniectomy and tumor resection guided by a custom-made 3D-printed cutting guide. The surgical defect was reconstructed with the prefabricated titanium plate achieving a good functional and cosmetic result.
Single-piece titanium plate cranioplasty is an effective novel reconstruction method for complex cranio-orbital defects.
已有多种方法用于颅骨缺损和眼眶缺损的重建。眶顶和额骨之间复杂的轮廓给预制颅眶重建带来了重大的设计挑战。在描述首例使用单片钛板颅骨成形术进行颅骨和眶顶联合重建的患者时，作者提出了一种新的复杂颅眶联合重建方法。
一名63岁女性患者，患有累及右侧眼眶和蝶骨翼的右侧额部平板状脑膜瘤。完整切除需要对颅骨和眶顶进行重建。手术预规划包括在三维（3D）打印的丙烯腈-丁二烯-苯乙烯模型上标记切除边缘。该边缘用于虚拟切除肿瘤并生成修复表面。然后使用液压冲压将钛板制作成3D打印模具，并对眶顶部分（一个凹入表面）进行手工精加工。在颅骨成形板上预制外眦和颞肌悬吊孔。
患者在定制的3D打印切割导板引导下接受了颅骨切除术和肿瘤切除术。用预制钛板重建手术缺损，取得了良好的功能和美容效果。
单片钛板颅骨成形术是一种用于复杂颅眶缺损的有效新型重建方法。
