title: One-step CAD/CAM titanium cranioplasty after drilling template-assisted resection of intraosseous skull base meningioma: technical note.
abstract: Cranial defects following intra-osseous tumor removal may be large and require adequate reconstruction. CAD/CAM implants have been used for years to achieve an optimal cosmetic result. The disadvantage is that such implants require a second surgery. A preoperative virtual planning of resection margins and the simultaneously fabrication of the cranioplasty could be a possibility to subsume the steps tumor resection and cosmetic restoration to a single procedure.
  
  
  
  We present two cases of patients with complex intra-osseous spheno-orbital meningioma. Tumor resection was performed with the help of a drilling template in form of a frame. The template also served as a negative for the computer-designed cranioplasty. The devices were manufactured by DMD GmbH - Digital Medical Design/DDI-Group, Dortmund, Germany.
  
  
  
  The usage of the template was highly practicable. Small adjustments in bone removal were necessary to achieve an optimal fitting of the implant. The 6-month follow-up showed for one patient a good and for one a satisfactory cosmetic result. No second surgery was necessary.
  
  
  
  Drilling template application could contribute to challenging cases of large fronto-basal meningiomas with the aim of minimizing operation time and achieving a good esthetic outcome.
authors.affiliation: Department of Neurosurgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-35, 44892, Bochum, Germany. anneelisabeth.carolus@kk-bochum.de.
authors.forename: A
authors.initials: A
authors.lastname: Carolus
authors.affiliation: Department of Maxillofacial and Craniofacial Surgery, Klinikum Dortmund, Dortmund, Germany.|IMDI - Institute for Medical and Dental Innovations, Associated Institute oft the University Witten/Herdecke, Witten, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Weihe
authors.affiliation: Department of Neurosurgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-35, 44892, Bochum, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Schmieder
authors.affiliation: Department of Neurosurgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-35, 44892, Bochum, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Brenke
mesh_terms: D000328:Adult; D017076:Computer-Aided Design; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D019292:Skull Base Neoplasms / Q000601:surgery*; D014025:Titanium
chemical_list: D014025:Titanium
keywords: CAD/CAM; Cosmetic outcome; Drilling template; Single-step resection and reconstruction; Skull base meningiomas; Titanium cranioplasty