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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 (Simpson 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

Postoperative CT following right orbitozygomatic craniotomy and cranial reconstruction
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FIG8: Postoperative CT following right orbitozygomatic craniotomy and cranial reconstruction

Mentions: The patient was taken to the operating room for a right frontotemporal orbitozygomatic craniotomy for tumor resection. Pathology revealed a meningioma without high-grade features consistent with World Health Organization (WHO) Grade II. Given extensive hyperostosis and invasion of the temporalis muscle, osteotomy of surrounding bone left the patient with a large defect in the area of the orbit and pterion. We utilized the dual mesh technique to reconstruct the curvature of the pterion. Surgical removal of the soft tissue tumor and bone were near total (Figure 7). A postoperative CT scan demonstrated symmetric re-approximation of the shape of the pterion as compared to the opposite side on postoperative CT imaging (Figure 8). At follow-up, the external cosmetic results of the surgery were deemed “very good” by the surgeon and patient.


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

Lau D, McDermott MW - Cureus (2015)

Postoperative CT following right orbitozygomatic craniotomy and cranial reconstruction
© Copyright Policy - open-access
Related In: Results  -  Collection

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

FIG8: Postoperative CT following right orbitozygomatic craniotomy and cranial reconstruction
Mentions: The patient was taken to the operating room for a right frontotemporal orbitozygomatic craniotomy for tumor resection. Pathology revealed a meningioma without high-grade features consistent with World Health Organization (WHO) Grade II. Given extensive hyperostosis and invasion of the temporalis muscle, osteotomy of surrounding bone left the patient with a large defect in the area of the orbit and pterion. We utilized the dual mesh technique to reconstruct the curvature of the pterion. Surgical removal of the soft tissue tumor and bone were near total (Figure 7). A postoperative CT scan demonstrated symmetric re-approximation of the shape of the pterion as compared to the opposite side on postoperative CT imaging (Figure 8). At follow-up, the external cosmetic results of the surgery were deemed “very good” by the surgeon and patient.

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 (Simpson 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