Application of 3-Dimensional Topographic Bone Thickness Map in Cranial Reconstruction Following Skull Lesion...

To evaluate the utility and clinical experience of using the 3-dimensional (3D) topographic bone thickness map in skull lesion resection and 1-stage cranioplasty.

A retrospective analysis was conducted on 32 patients who underwent skull lesion resection and 1-stage cranioplasty using polyether ether ketone (PEEK) between December 2019 and December 2023. Preoperative thin-slice cranial computed tomography data were used to reconstruct 3D topographic bone thickness maps employing a pseudocolor technique to determine lesion margins, fabricate PEEK implant, and make surgical strategies (topographic group). The conventional group used similar workflow with the conventional 3D computed tomography images. Cranioplasty was carried out with PEEK implants following lesion resection at the same time.

Patients' ages ranged from 3 years to 67 years (median, 26 years). Postoperative pathology confirmed Langerhans cell histiocytosis (LCH) (n = 8), fibrous dysplasia (n = 8), meningioma (n = 13), lymphoma (n = 2), and sarcoma (n = 1). Partial resection was performed in 4 patients with fibrous dysplasia and 3 patients with LCH cases, while the remaining 25 cases underwent total resection. No severe complications such as hemorrhage, infection, or poor wound healing were observed. Three patients with multisite LCH received postoperative chemotherapy and 3 patients with aggressive meningiomas underwent radiotherapy after surgery. Follow-up over 2-6 years revealed no recurrence. In the topographic group, the PEEK implants achieved a universally accurate intraoperative fit, and the operative time was significantly shorter than that of the conventional group.

The 3D topographic bone thickness map holds clinical value (precise, convenient, and time saving) in guiding skull lesion resection and cranioplasty.