title: Intraoperative patient-specific reconstruction of partial bone flap defects after convexity meningioma resection.
abstract: OBJECTIVE
  To evaluate implant accuracy and cosmetic outcome of a new intraoperative patient-specific cranioplasty method after convexity meningioma resection.
  
  
  METHODS
  The patient's own bone flap served as a template to mold a negative form with the use of polymethyl methacrylate (PMMA). The area of bone invasion was determined and broadly excised under white light illumination with a safety margin of at least 1 cm. The definitive replica was cast within the remaining bone flap frame and the imprint. Clinical and radiologic follow-up examinations were performed 3 months after surgery.
  
  
  RESULTS
  Four women and two men (mean age 51.4 years±12.8) underwent reconstruction of bone flap defects after meningioma resection. Mean duration of intraoperative reconstruction of the partial bone flap defects was 19 minutes±4 (range 14-24 minutes). Implant sizes ranged from 17-35 cm2 (mean size 22 cm2±8). Radiologic and clinical follow-up examinations revealed excellent implant alignment and favorable cosmesis (visual analogue scale for cosmesis [VASC]=97±5) in all patients.
  
  
  CONCLUSIONS
  Patient-specific reconstruction of partial bone flap defects after convexity meningioma resection using the presented intraoperative PMMA cast method resulted in excellent bony alignment and a favorable cosmetic outcome. Relatively low costs and minimized operation time for adjustment and insertion of the cranioplasty implant justify use of this method in small bony defects as well.
authors.affiliation: Department of Neurosurgery, Kantonsspital, Aarau, Switzerland. serge.marbacher@ksa.ch
authors.forename: Serge
authors.initials: S
authors.lastname: Marbacher
authors.forename: Daniel
authors.initials: D
authors.lastname: Coluccia
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Fathi
authors.forename: Lukas
authors.initials: L
authors.lastname: Andereggen
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
authors.forename: Javier
authors.initials: J
authors.lastname: Fandino
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000601:surgery*; D012888:Skull Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: D019904:Polymethyl Methacrylate