Page 88 - Clinical relevance of current materials for cranial implants

Chapter 4
MATERIALS AND METHODS
Case
In 2001, a 27-year-old man, with diabetes mellitus type II, visited the department of neurosurgery with complaints of sensory disturbances in the right side of his body, character changes, diminished vision, and dysphasia. Magnetic resonance imaging was performed and the patient was provisionally diagnosed with a bilateral parieto- occipital meningioma with reactive changes of the cranial bone (Figure 1). A total resection was indicated, and a direct reconstruction of the cranial defect planned.
A bi-coronal incision was performed, a skin flap detached, and involved bone surgically visualized and removed. The resulting defect had a circumference of 400mm. After tumor resection and closure of the dura, a PMMA cranioplasty was prepared according to the manufacturer’s instructions using CMW-3 (DePuy International Ltd., Leeds, United Kingdom). The malleable PMMA was put into the defect for the correct size and molding, after the dura was protected with damp gauzes. After hardening small adjustments were made with a burr to create a perfect fit. After this, the cranioplasty was fixed with sutures. After closure of the skull defect a subcutaneous wound drain was placed. The total operation time was approximately 14 hours with 4.5 L blood loss. The pathologic diagnosis was as expected: meningotheliomatous (syncytial) meningioma (World Health Organization grade I) with ingrowth into the cranial bone.
Figure 1: Preoperative sagittal (left) and coronal (right) T1-weighted MR-image after intravenous gadolinium.
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