gms | German Medical Science

Objective: The therapy of skull base meningiomas is comprehensive and complex. The treatment consists of extensive resection of the lesion and consecutive reconstruction of the meninges and of the skull. Especially in fronto-basal and in sphenoid-wing meningiomas, the cosmetic result is of utmost importance. Here, we present our experience in the treatment of skull base meningiomas focusing on the reconstruction of the neurocranium with individually preformed titanium cranioplasty (CRANIOTOP^®, CL Instruments, Germany).

Method: In this retrospective analysis, 7 patients (2 male, 5 female; mean age 55.0 years) were included. In four patients, the titanium cranioplasty (TC) was applied after removal of a previously implanted polymethylmethacrylat (PMMA) cranioplasty. In two patients, the preformed TC was inserted subsequently after tumor resection. One patient received the TC (preformed on the basis of a new CT-scan revealing the skull defect after the initial tumor resection) in a second procedure. The patient data collected for evaluation included clinical presentation, tumor localization and extension, histopathology, surgery time, postoperative complications and the cosmetic result. The postoperative CT-scan was screened for any postoperative hemorrhage. The mean follow-up time was 6 months.

Results: The histological workup revealed WHO I meningioma in 6 patients and one patient with a WHO II meningioma. Mean operating time was 158 minutes (range 67-281 minutes; median 140 minutes). One TC was explanted due to a postoperative wound infection and in one patient a cerebrospinal fluid (CSF) fistula necessitated surgical repair without explantation of the TC. Neither did we encounter any postoperative scalp necrosis nor did we register seizures, neuropathia or pseudomeningocele, postoperatively. The postoperative CT-scan revealed accurate fitting of the TC and appropriate closure of the skull defect. The cosmetic result was excellent in all cases. A postoperative nuclear magnetic resonance (NMR) scan was performed in one patient without any relevant artifacts.

Conclusions: The handling of the prefabricated TC was easy and did not extent the surgery time disproportionally. The material showed a very good biocompatibility and yielded satisfying cosmetic results. TC is an appropriate and safe tool for immediate skull reconstruction after to extended skull base surgery.