Single-step 3D printing aided cranio-orbital reconstruction with patient specific polyetheretherketone implants after resection of benign spheno-orbital tumors

• Published in: Acta neurochirurgica 2024-12, Vol.166 (1), p.499
• Main Authors: Rezai, Arwin, Pöppe, Johannes P., Gaggl, Alexander, Griessenauer, Christoph J., Schwartz, Christoph, Krainz, Herbert, Ueberschaer, Moritz, Mercea, Petra A., Enzinger, Simon
• Format: Article
• Language: English
• Subjects: 3-D printers; Adult; Aged; Benzophenones; Complications; Computer-Aided Design; Female; Humans; Integrated approach; Interventional Radiology; Ketones; Male; Maxillofacial; Medicine; Medicine & Public Health; Meningioma; Meningioma - diagnostic imaging; Meningioma - surgery; Middle Aged; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Orbit - diagnostic imaging; Orbit - surgery; Orbital Neoplasms - diagnostic imaging; Orbital Neoplasms - surgery; Patients; Plastic Surgery Procedures - instrumentation; Plastic Surgery Procedures - methods; Polyethylene Glycols; Polymers; Postoperative; Printing, Three-Dimensional; Prostheses and Implants; Reconstructive surgery; Retrospective Studies; Sphenoid Bone - surgery; Surgical Orthopedics; Transplants & implants; Tumors; Wound healing
• ISSN: 0001-6268; 0942-0940; 0942-0940
• DOI: 10.1007/s00701-024-06393-4

Purpose Computer-aided design (CAD) and computer-aided manufacturing (CAM) techniques have paved the way for single-step resections and cranio-orbital reconstructions with patient specific implants in spheno-orbital tumors. Here, we present our interdisciplinary maxillofacial and neurosurgical workflow and a case series of patients treated with this integrated approach. Methods Patients, who underwent single-step resection of benign spheno-orbital tumors and cranio-orbital reconstruction with polyetheretherketone (PEEK) patient specific implants (PSI) from 2019 to 2024 in our institution were included. Three dimensional models of the tumor, the skull, the implants and the cutting guides were integrated into intraoperative neuronavigation and 3D printed at the point of care (POC) for surgical planning. Clinical data was retrospectively analyzed, pre- and postoperative Exophthalmic index (EI) was radiologically determined. Results Eleven patients met inclusion criteria. Meningioma WHO grade 1 was the most common tumor entity (81.8%). In a majority of patients, exophthalmos was the presenting sign (63.6%). Postoperative cranial imaging revealed an optimal position of the PEEK implants with regredient EI in 88.9%. Four (36.4%) patients, of whom two (50%) had undergone prior tumor resections, suffered from surgical complications. The most commonly recorded complication was impaired wound healing ( n  = 2). Tumor recurrence was observed in one (9.1%) patient at six months follow-up. Conclusions Single-step resection and reconstruction in spheno-orbital tumors with PEEK PSIs is feasible and combines surgical expertise, virtual implant design and 3D printing techniques. Favorable aesthetical, visual and oncological outcomes were achieved in this cohort, despite a significant risk for postoperative complications.