Rezai Arwin, Pöppe Johannes P, Gaggl Alexander, Griessenauer Christoph J, Schwartz Christoph, Krainz Herbert, Ueberschaer Moritz, Mercea Petra A, Enzinger Simon
Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Department of Oral and Maxillofacial Surgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Acta Neurochir (Wien). 2024 Dec 12;166(1):499. doi: 10.1007/s00701-024-06393-4.
Computer-aided design (CAD) and computer-aided manufacturing (CAM) techniques have paved the way for single-step resections and cranio-orbital reconstructions with patient specific implants in spheno-orbital tumors. Here, we present our interdisciplinary maxillofacial and neurosurgical workflow and a case series of patients treated with this integrated approach.
Patients, who underwent single-step resection of benign spheno-orbital tumors and cranio-orbital reconstruction with polyetheretherketone (PEEK) patient specific implants (PSI) from 2019 to 2024 in our institution were included. Three dimensional models of the tumor, the skull, the implants and the cutting guides were integrated into intraoperative neuronavigation and 3D printed at the point of care (POC) for surgical planning. Clinical data was retrospectively analyzed, pre- and postoperative Exophthalmic index (EI) was radiologically determined.
Eleven patients met inclusion criteria. Meningioma WHO grade 1 was the most common tumor entity (81.8%). In a majority of patients, exophthalmos was the presenting sign (63.6%). Postoperative cranial imaging revealed an optimal position of the PEEK implants with regredient EI in 88.9%. Four (36.4%) patients, of whom two (50%) had undergone prior tumor resections, suffered from surgical complications. The most commonly recorded complication was impaired wound healing (n = 2). Tumor recurrence was observed in one (9.1%) patient at six months follow-up.
Single-step resection and reconstruction in spheno-orbital tumors with PEEK PSIs is feasible and combines surgical expertise, virtual implant design and 3D printing techniques. Favorable aesthetical, visual and oncological outcomes were achieved in this cohort, despite a significant risk for postoperative complications.
计算机辅助设计（CAD）和计算机辅助制造（CAM）技术为蝶眶肿瘤患者使用定制植入物进行单步切除和颅眶重建铺平了道路。在此，我们展示我们的跨学科颌面和神经外科工作流程以及一系列采用这种综合方法治疗的患者病例。
纳入2019年至2024年在我们机构接受蝶眶良性肿瘤单步切除并使用聚醚醚酮（PEEK）定制植入物（PSI）进行颅眶重建的患者。将肿瘤、颅骨、植入物和切割导板的三维模型整合到术中神经导航中，并在床边（POC）进行3D打印以用于手术规划。对临床数据进行回顾性分析，通过影像学确定术前和术后的眼球突出指数（EI）。
11名患者符合纳入标准。世界卫生组织1级脑膜瘤是最常见的肿瘤类型（81.8%）。大多数患者以眼球突出为主要症状（63.6%）。术后头颅影像学显示88.9%的PEEK植入物位置最佳，EI有所改善。4名（36.4%）患者出现手术并发症，其中2名（50%）曾接受过肿瘤切除术。最常见的并发症是伤口愈合不良（n = 2）。在6个月的随访中，1名（9.1%）患者出现肿瘤复发。
使用PEEK PSI对蝶眶肿瘤进行单步切除和重建是可行的，它结合了手术专业知识、虚拟植入物设计和3D打印技术。尽管术后并发症风险较高，但该队列取得了良好的美学、视觉和肿瘤学效果。
