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Virtual Surgical Planning for Intracranial Intraosseous Meningioma Reconstruction
Rema Shah1, Xiaona Lu, Jacob Dinis
1Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT.
Objective:
To assess the use of custom-made intracranial implants and three-dimensional cutting guides to direct the intracranial, intraorbital, and temporal reconstruction process for intraosseous meningioma.
Methods:
A retrospective analysis was conducted on 6 patients who were operated on by the senior author for intraosseous meningioma between 2017 and 2020. Three-dimensional models of the maxillofacial skeleton were created from preoperative virtual planned reconstruction and postoperative computed tomography scan images in the Mimics and 3-Matics software. Orbital reconstruction and temporal implant accuracy assessments were performed through the Materialise Mimics software.
Results:
Orbital cone volume had a mean discrepancy between the planned and actual orbital volume of 1.5% ± 1.6%. The reconstructed postoperative orbital volume was within 1.3% ± 2.0% of the unaffected orbit. Temporal bone reconstructions had a mean implant accuracy of 81.0%.
Conclusions:
Our results show that the postextirpative intracranial applications of virtual surgical planning are particularly suited for high fidelity reconstructions such as orbital reconstructions, as well as temporal reconstructions with intraoperative adjustments. Custom implants and virtual three-dimensional planning is particularly ideal and promising for intraosseous meningiomas given the involvement of complex intracranial and intraorbital bony structures.
