Page 132 - Clinical relevance of current materials for cranial implants

Chapter 6
Surgical procedure
Intraoperatively, the meningioma was surgically exposed and the temporal muscle was partially detached from the orbit and pterion (Figure 5A). The resection template was temporarily fixed with ten 10 mm screws. The resection of the meningioma was performed with a piezo-surgical instrument (Figure 5B). The resected meningioma and pathologically involved dura mater were consequently removed (Figure 5C). A subgaleal flap was transferred and sutured to close the dural defect. The control template was used to resect excess bony ledges that would hamper a good fit. Tangential burr holes were created following the InterFix® guide and the PSI was fixed to the surrounding bone (Figure 5D). The temporal muscle and fascia were partially sutured to the PSI with Xsuture® (Figure 5E). Total operating time was 430 minutes. No intra-operative complications occurred. After three years, no clinical signs of infection, haemorrhage, or other complications relating to the implant were observed. The aesthetic result remained satisfactory as subjectively judged by patient and clinician. The post-operative CT-scan showed no irregularities.
Figure 5: Intra-operative photographs of A) exposed meningioma, B) fixed nylon resection template, C) total resection of the meningioma, D) fixed PEEK patient specific implant, E) suspension of temporal muscle.
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