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A Method for Combining Thin and Thick Malleable Titanium Mesh in the Repair of Cranial Defects.

Lau D, McDermott MW - Cureus (2015)

Bottom Line: A 30-year-old woman presented with painless proptosis and was found to have a hyperostosing right sphenoid wing meningioma.Postoperative CT imaging demonstrated symmetric re-approximation of the shape of the pterion as compared to the opposite side.We present a method for connecting two titanium mesh sheets with available hardware to improve the strength in compression while maintaining the ability to mold thinner sheets as necessary for the best cosmetic results.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurological Surgery, University of California, San Francisco.

ABSTRACT

Introduction: Cranial defects following the removal of tumor involved bone require repair and reconstruction for brain protection and cosmesis. A variety of autologous bone substrates and synthetic materials can be employed, alone or in combination. In this article, we describe the use of dual thin and thick titanium mesh, connected together using plate hardware, to repair a right frontotemporal sphenoidal bone defect following resection of a hyperostosing sphenoid wing meningioma.

Methods: Reconstruction of the pterion was done with a dual mesh cranioplasty. After replacement of the native orbitozygomatic and frontotemporal bone pieces, a piece of thinner mesh was molded to the pterional defect connecting the two bone pieces and re-creating the concave shape of the pterion below the superior temporal line. The circular area of the bony defect overlying the frontal and temporal lobes was supplemented by cutting and molding an additional piece of thicker mesh which was secured to the thinner mesh with burr hole cover sectors using rescue screws.

Results: A 30-year-old woman presented with painless proptosis and was found to have a hyperostosing right sphenoid wing meningioma. The patient underwent a frontotemporal orbitozygomatic craniotomy for tumor resection and extensive bony osteotomy. Repair and reconstruction of the cranial defect in the region were accomplished at the time of open operation using two thicknesses of mesh connected one to another with titanium plate pieces and rescue screws. The patient underwent gross total resection of the meningioma and near total resection of the soft tissue and bony components (SimpsonĀ Grade II). The external cosmetic results following the orbital-cranial reconstruction with the dual mesh technique was deemed "very good" by the surgeon and patient. Postoperative CT imaging demonstrated symmetric re-approximation of the shape of the pterion as compared to the opposite side.

Conclusions: We present a method for connecting two titanium mesh sheets with available hardware to improve the strength in compression while maintaining the ability to mold thinner sheets as necessary for the best cosmetic results. This method is an option for coverage of bony defects in the region of the pterion for young, physically active patients providing them with additional mesh cranioplasty strength.

No MeSH data available.


Related in: MedlinePlus

Preoperative MRI and CT imaging of right middle fossa meningioma(A) Axial T1-weight MRI with contrast revealing a right middle fossa meningioma with associated hyperostosis of surrounding bone and invasion of the temporalis muscle. (B and C) Extensive bony hyperostosis of the right lateral orbit and pterion.
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FIG6: Preoperative MRI and CT imaging of right middle fossa meningioma(A) Axial T1-weight MRI with contrast revealing a right middle fossa meningioma with associated hyperostosis of surrounding bone and invasion of the temporalis muscle. (B and C) Extensive bony hyperostosis of the right lateral orbit and pterion.

Mentions: A 30-year-old female presented with painless right eye proptosis and was found to have a right middle fossa meningioma with extensive hyperostosis of surrounding bone with extension into the temporalis muscle (Figure 6). Informed patient consent was obtained for this study.


A Method for Combining Thin and Thick Malleable Titanium Mesh in the Repair of Cranial Defects.

Lau D, McDermott MW - Cureus (2015)

Preoperative MRI and CT imaging of right middle fossa meningioma(A) Axial T1-weight MRI with contrast revealing a right middle fossa meningioma with associated hyperostosis of surrounding bone and invasion of the temporalis muscle. (B and C) Extensive bony hyperostosis of the right lateral orbit and pterion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494541&req=5

FIG6: Preoperative MRI and CT imaging of right middle fossa meningioma(A) Axial T1-weight MRI with contrast revealing a right middle fossa meningioma with associated hyperostosis of surrounding bone and invasion of the temporalis muscle. (B and C) Extensive bony hyperostosis of the right lateral orbit and pterion.
Mentions: A 30-year-old female presented with painless right eye proptosis and was found to have a right middle fossa meningioma with extensive hyperostosis of surrounding bone with extension into the temporalis muscle (Figure 6). Informed patient consent was obtained for this study.

Bottom Line: A 30-year-old woman presented with painless proptosis and was found to have a hyperostosing right sphenoid wing meningioma.Postoperative CT imaging demonstrated symmetric re-approximation of the shape of the pterion as compared to the opposite side.We present a method for connecting two titanium mesh sheets with available hardware to improve the strength in compression while maintaining the ability to mold thinner sheets as necessary for the best cosmetic results.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurological Surgery, University of California, San Francisco.

ABSTRACT

Introduction: Cranial defects following the removal of tumor involved bone require repair and reconstruction for brain protection and cosmesis. A variety of autologous bone substrates and synthetic materials can be employed, alone or in combination. In this article, we describe the use of dual thin and thick titanium mesh, connected together using plate hardware, to repair a right frontotemporal sphenoidal bone defect following resection of a hyperostosing sphenoid wing meningioma.

Methods: Reconstruction of the pterion was done with a dual mesh cranioplasty. After replacement of the native orbitozygomatic and frontotemporal bone pieces, a piece of thinner mesh was molded to the pterional defect connecting the two bone pieces and re-creating the concave shape of the pterion below the superior temporal line. The circular area of the bony defect overlying the frontal and temporal lobes was supplemented by cutting and molding an additional piece of thicker mesh which was secured to the thinner mesh with burr hole cover sectors using rescue screws.

Results: A 30-year-old woman presented with painless proptosis and was found to have a hyperostosing right sphenoid wing meningioma. The patient underwent a frontotemporal orbitozygomatic craniotomy for tumor resection and extensive bony osteotomy. Repair and reconstruction of the cranial defect in the region were accomplished at the time of open operation using two thicknesses of mesh connected one to another with titanium plate pieces and rescue screws. The patient underwent gross total resection of the meningioma and near total resection of the soft tissue and bony components (SimpsonĀ Grade II). The external cosmetic results following the orbital-cranial reconstruction with the dual mesh technique was deemed "very good" by the surgeon and patient. Postoperative CT imaging demonstrated symmetric re-approximation of the shape of the pterion as compared to the opposite side.

Conclusions: We present a method for connecting two titanium mesh sheets with available hardware to improve the strength in compression while maintaining the ability to mold thinner sheets as necessary for the best cosmetic results. This method is an option for coverage of bony defects in the region of the pterion for young, physically active patients providing them with additional mesh cranioplasty strength.

No MeSH data available.


Related in: MedlinePlus