Page 144 - Clinical relevance of current materials for cranial implants
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                                Chapter 7
ABCD
Figure 3: The 3D virtual planned resection and reconstruction with a PEEK cranioplasty. A) Segmentation of the tumor. B) Design of the resection template. C) Design of the control template. D) Design of the cranioplasty.
Surgical procedure
Preoperatively 2 gram cefalozin was administered intravenously and continued during the surgical procedure 1 gram every 4 hours. The patient was placed in right lateral position with the head fixated with the Mayfield clamp. Navigation (Brainlab, Munich, Germany) for the perfect position of the resection template was calibrated and installed. After this, a sterile operation field was created according to normal procedures.
Phase I – Tumor resection
The soft tissue outline of the cSCC including at least 1 cm free margin was marked and the skin incision was performed. After the skin incision, a careful subperiosteal dissection was performed to allow proper positioning of the resection template (Figure 4A). Periosteal attachment around the region of bony invasion was maintained.
The resection template positioning was controlled with the use of navigation and fixed with 4 screws of 6 mm into the skull. Four burr holes, two frontal and two parietal, were prepared and the craniectomy was performed guided by the resection template. (Figure 4B&4C) With the use of the control template adjustments were made to allow a proper fit of the Patient Specific Implant (PSI) of PEEK in a later stage of the surgical procedure.
Phase II – Dissection of temporal artery and vein simultaneous with harvesting of the latissimus dorsi flap
After tumor resection, dissection of a free LD flap with the thoracodorsal artery as vascular pedicle was performed. Simultaneously, the superficial temporal artery and external jugular vein were dissected and prepared as recipient vessels for arterial and venous anastomosis of the vascular pedicle after free tissue transfer.
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