title: Immediate Single-Stage Cranioplasty Following Calvarial Resection for Benign and Malignant Skull Neoplasms Using Customized Craniofacial Implants.
abstract: Craniectomy defects following resection of calvarial lesions are most often reconstructed using on-table manufacturing. With the advent of computer-aided design/manufacturing and customized craniofacial implants (CCIs), there seems to be more suited alternatives. In this study, the authors report their institutional experience and outcome using immediate, single-stage, CCI-based reconstruction for benign and malignant skull neoplasm defects.
  
  
  METHODS
  A retrospective review of a prospectively maintained database of all implant cranioplasties performed between 2011 and 2014, by a single craniofacial surgeon at a tertiary academic medical institution was performed. Preoperative and postoperative computed tomography scans with 3D reconstruction were performed for the purpose of assessing adequate resection and reconstructive outcomes. Primary endpoints included length of surgery, predicted defect versus postoperative implant surface area, contour irregularities, and complications.
  
  
  RESULTS
  Of the 108 patients with cranioplasty identified, 7 patients were found to undergo immediate CCI-based reconstruction for calvarial neoplasms; 4 patients (4/7, 57%) presented with malignant pathology. All defects were >5  cm2. As compared with their original size, all implants were modified intraoperatively between 0.2% and 40.8%, with a mean of 13.8%. With follow-up ranging between 1 and 16 months, there were no implant-related complications identified. The immediate and long-term aesthetic results, as well as patient satisfaction, were ideal.
  
  
  CONCLUSIONS
  With this preliminary experience, the authors have successfully demonstrated that immediate customized implant reconstructive techniques, by way of intraoperative modification, are both safe and feasible for benign and malignant skull neoplasms. The authors believe that with wider acceptance of this multidisciplinary approach and increased surgeon familiarity, this technique will soon become the reconstructive standard of care.
authors.affiliation: *Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, the Johns Hopkins Hospital †Johns Hopkins School of Medicine, Baltimore, MD ‡University of Illinois College of Medicine, Rockford, IL §Department of Neurosurgery, Johns Hopkins School of Medicine, the Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Jens U
authors.initials: JU
authors.lastname: Berli
authors.forename: Lauren
authors.initials: L
authors.lastname: Thomaier
authors.forename: Shuting
authors.initials: S
authors.lastname: Zhong
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quinones
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
authors.forename: Jon
authors.initials: J
authors.lastname: Weingart
authors.forename: Henry
authors.initials: H
authors.lastname: Brem
authors.forename: Chad R
authors.initials: CR
authors.lastname: Gordon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017076:Computer-Aided Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D012888:Skull Neoplasms / Q000601:surgery*