Evolution of Single-Stage Extirpation and Reconstruction for Cranial/Intracranial Tumors: Use of CAD/CAM and Interdisciplinary Care

Abstract

Objective:

In order to streamline patient care and optimize outcomes, we have undertaken a protocol for patients with cranial/intracranial tumors whereby coordinated resection and reconstruction are performed in a single stage procedure using a virtually planned craniotomy, guides, and implants. This represents an advanced interdisciplinary approach offering operative efficiency while avoiding many clinical and technical challenges. We present our experience and a 9-patient series using this method.

Methods:

Patients with cranial/intracranial tumors which would create a defect from extirpation or with inadequate bone following repeated craniotomies were evaluated by neurosurgery and craniofacial surgery teams. A virtual surgical planning (VSP) webinar was attended by both services, where extirpation and reconstruction were simultaneously planned. For resection cases, cranial CT images were superimposed with MRI to register precise tumor location in relation to bone anatomy. The virtually planned craniotomy position was transferred to the operating room with a custom cutting guide registered to the patient’s cranial contours. Finally, immediate reconstruction was performed using a custom 3D polyether ether ketone (PEEK) implant designed to extend precisely to the edges of the guided craniotomy.

Results:

Nine patients age 29 to 79 years old (mean = 55) underwent coordinated tumor extirpation and cranial reconstruction via our workflow. They were followed for 28 to 65 months (mean = 42.2). There were no intraoperative complications. One patient developed transient blurry vision which resolved. One patient with history of repeated meningioma removal developed recurrence. All patients have healed without long-term complications, and there have been no explants from these procedures.

Conclusion:

Our single-stage protocol for cranial tumor extirpation and cranial reconstruction, which includes collaborative preoperative consultation and VSP, is versatile and effective. The use of computer-generated cutting guides and custom implants obviates intraoperative improvisation and minimizes reoperation. Ultimately, this interdisciplinary approach improves the esthetic and functional results for patients, representing an advancement in cranial defect reconstruction.