Abstract
Purpose: :
Pterional-orbitozygomatic craniotomies provide access to both the orbital and intracranial spaces. When utilized in the resection of neoplastic disease, large defects in the superior and lateral orbital walls result. A recently developed implant embeds a titanium mesh within porous polyethylene. We describe our experience using this implant.
Methods: :
In this retrospective university based study, we reviewed the medical records of eight consecutive patients (mean age 54, range 34 to 78 years of age; 1 man, 7 women) during the time period, July 2008 to July 2009. All patients underwent pterional-orbitozygomatic craniotomy with resection portions of the superior and lateral orbital walls with reconstruction using the Medpor Titan implant.
Results: :
Indications for surgery were sphenoid wing meningioma (n=6), adenoid cystic carcinoma (n=1), and pachymeningitis (n=1).In all patients surgery was performed similarly. Following completion of tumour resection, the size of the defect in the orbital wall was assessed (3 to 12 cm2). Slightly larger sized implants were cut, such that 3 to 4 mm of overlap was achieved medially and laterally, and shaped, matching the shape of the excised bone. Edges are secured under (occasionally over) solid bone medially and laterally. Anterior, one to three titanium screws are used to fix the implant to the superior orbital rim. The craniotomy bone flap is then secured in a standard fashion.In all patients proptosis was either improved or normalized. No implant related complications were seen. This includes implant migration/displacement, infection, abnormalities in extraocular motility or the development of enophthalmos or pulsatile proptosis.
Conclusions: :
Based on our initial experience, due in part to its malleability and ability to retain shape, the Titan Medpor implant appears to be well suited to replace complex orbital wall defects of varying size and shape. Admittedly, this is a small retrospective study and its role in orbito-cranial reconstruction continues to evolve.