Split calvarial bone graft in cranio-orbital sphenoid wing reconstruction

Sphenoid wing defects of the posterior orbit and frontal and middle cranial fossae, secondary to tumor ablation, create difficulties in orbital and cranial base reconstruction. Autogenous split calvarial bone grafts harvested at the time of neurosurgical tumor ablation were used to reconstruct sphenoid wing defects in nine patients between July 1983 and January 1993. Meningioma is the most common tumor resected in this series, followed by fibrous dysplasia. Patient follow-up ranged from 1 to 5 years with a mean of 3 years. Calvarial bone grafting was performed to restore continuity of frontal bone, supraorbital ridge, orbital roof, and lateral wall and floor. All patients demonstrating proptosis showed either complete resolution or significant improvement postoperatively by exophthalmometry. Postoperative pulsatile exophthalmos occurred transiently in one patient but resolved spontaneously. Postoperative diplopia occurred in two patients, which subsequently resolved within 6 weeks. There were no incidents of postoperative osteomyelitis or bone graft loss within the reported postoperative period. Conventional and three-dimensional computed axial tomographic scans did not demonstrate bony resorption resulting in structural instability in any of the cases with this reconstructive method.