title: Single-staged resections and 3D reconstructions of the nasion, glabella, medial orbital wall, and frontal sinus and bone: Long-term outcome and review of the literature.
abstract: BACKGROUND
  Aesthetic facial appearance following neurosurgical ablation of frontal fossa tumors is a primary concern for patients and neurosurgeons alike. Craniofacial reconstruction procedures have drastically evolved since the development of three-dimensional computed tomography imaging and computer-assisted programming. Traditionally, two-stage approaches for resection and reconstruction were used; however, these two-stage approaches have many complications including cerebrospinal fluid leaks, necrosis, and pneumocephalus.
  
  
  METHODS
  We present two successful cases of single-stage osteoma resection and craniofacial reconstruction in a 26-year-old female and 65-year-old male. The biopolymer implants were preselected and contoured based on imaging prior to surgery. The ideal selection of appropriate flaps for reconstruction was imperative. The flaps were well vascularized and included a pedicle for easy translocation. Using a titanium mesh biopolymer implant for reconstruction in conjunction with a forehead flap proved advantageous, and the benefits of single-stage approaches were apparent. The patients recovered quickly after the surgery with complete resection of the osteoma and good aesthetic appearance. The flap adhered to the biopolymer implant, and the cosmetic appearance years after surgery remained decent. The gap between the bone and implant was less than 2 mm. The patients are highly satisfied with the symmetrical appearance of the reconstruction.
  
  
  CONCLUSIONS
  Advances in technology are allowing neurosurgeons unprecedented opportunities to design complex yet feasible single-stage craniofacial reconstructions that improve a patient's quality of life by enhancing facial contours, aesthetics, and symmetry.
authors.affiliation: Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Ciporen
authors.affiliation: Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Brandon P
authors.initials: BP
authors.lastname: Lucke-Wold
authors.affiliation: Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Mendez
authors.affiliation: Department of ENT, Kaiser Permanente, Sacramento, California, USA.
authors.forename: Anton
authors.initials: A
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Kaiser Permanente, Sacramento, California, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Department of Neurosurgery, Kaiser Permanente, Sacramento, California, USA.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Akins
authors.affiliation: Department of ENT, Kaiser Permanente, Sacramento, California, USA.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Balough
keywords: Biopolymers; craniofacial reconstruction; implants; osteoma; single-stage approach