Department of Maxillofacial Surgery, "M. Bufalini" Hospital, Romagna Health System, Cesena, Italy.
Department of Neurosurgery.
J Craniofac Surg. 2021;32(5):1870-1873. doi: 10.1097/SCS.0000000000007385.
In the last few years, skull base tumors involving the fronto-orbital region have been approached with complex, invasive, and time-consuming cranial reconstruction techniques. On the other hand, recent custom-made implants allow easier and faster procedures, with excellent aesthetic results. The authors propose an easy surgical-planned protocol with a synchronized "one-step" resection and reconstruction of these complex lesions, with a preformed poly-methyilmethacrylate (PMMA) cranioplasty.
Our technique consists of a 2-phases procedure. In the first one, the so-called "virtual" phase, the authors get a tailored 3D-PMMA model based on high-resolution (HR) CT-scans of the patient's skull. Afterward, the authors perform the planned craniotomy on the 3D-PMMA model with the assistance of intraoperative navigation system. Therefore, a further CT-scan of the resected model is performed to develop the final implant. In the second phase, the "surgical phase," a single procedure consisting in a cranial resection and custom reconstruction is performed with the assistance of stealth-navigation. The authors describe 6 cases of complex fronto-orbital-sphenoidal benign tumors that required skull reconstruction. All patients were examined 3 months after surgery through cosmetic (facial and eyes symmetry and globe position) and ophthalmology tests (visual field, visual impairment, and diplopia). Postsurgical HR CT-scans of the head and MRI-scans of the brain documented a total resection of the tumor and an optimal accuracy of skull reconstruction.
In all cases, the authors obtained a highly accurate skull reconstruction following cranio-orbital tumor resection, with a less aggressive and faster procedure compared to autologous bone graft. Final cosmetic and functional results were excellent, with good results in cases of presurgical exophthalmos and orbital asymmetry. None of the patients developed implant-related complications.
The "one-step" resection and reconstruction of benign tumors involving the spheno-orbital region with neuronavigation assistance is a technique that allows an accurate tumor removal and a cranial-bone reconstruction within a single surgical procedure, with fewer complications and excellent cosmetic and functional results.
在过去的几年中，涉及额眶区域的颅底肿瘤已经采用了复杂、侵入性和耗时的颅重建技术进行治疗。另一方面，最近的定制植入物允许更简单、更快的手术，并获得极好的美学效果。作者提出了一种简单的手术计划方案，通过预成型的聚甲基丙烯酸甲酯（PMMA）颅骨成形术，对这些复杂病变进行同步的“一步式”切除和重建。
我们的技术包括两阶段程序。在第一阶段，即所谓的“虚拟”阶段，作者根据患者颅骨的高分辨率（HR）CT 扫描，获得定制的 3D-PMMA 模型。之后，作者在术中导航系统的协助下，在 3D-PMMA 模型上进行计划的开颅手术。因此，对切除模型进行进一步的 CT 扫描，以开发最终的植入物。在第二阶段，即“手术”阶段，通过隐形导航辅助进行单次手术，包括颅骨切除和定制重建。作者描述了 6 例需要颅骨重建的复杂额眶蝶窦良性肿瘤病例。所有患者均在术后 3 个月接受了美容（面部和眼睛对称以及眼球位置）和眼科检查（视野、视力障碍和复视）。术后头部高分辨率 CT 扫描和脑部 MRI 扫描证实了肿瘤的完全切除和颅骨重建的高度准确性。
在所有病例中，作者在颅眶肿瘤切除后获得了高度精确的颅骨重建，与自体骨移植相比，手术过程侵袭性更小、速度更快。最终的美容和功能效果极佳，对于术前眼球突出和眼眶不对称的病例效果良好。无患者发生与植入物相关的并发症。
在神经导航辅助下，对涉及蝶眶区域的良性肿瘤进行“一步式”切除和重建是一种技术，可在单次手术中实现精确的肿瘤切除和颅骨重建，并发症较少，美容和功能效果极佳。
