3D Printed Models for Surgical Planning and Reconstructive Implant Design in Sphenoorbital Tumor Surgery

Aim: Spheno-orbital hyperostotic tumors require extensive bony resection to achieve the desired cosmetic, visual and oncological outcome. Orbital reconstruction method is controversial. We review the use of 3D printed models for surgical planning subsequent design of a reconstructive implant after combined sphenoorbital extensive resection.

Methods: Retrospective review of six patients with sphenoorbital tumors operated between August 2012 and July 2014. All patients underwent helical 3D CT before surgery. The intended resection defined to remove all involved bone including the orbital rim, anterior clinoidectomy and optic canal where necessary. A model depicting the resection margin printed. Reconstructive implant fashioned based on the contours of the contralateral side. The implant material was dependent on the anticipated need for adjuvant radiotherapy (Poly-ether-ether-ketone (PEEK) or titanium).

Results: Five meningiomas (one recurrent, one previous prosthesis failure) and one fibrous dysplasia. All presented with visual deficit and proptosis. Median age was 49.5 years; median follow-up was 22 months. Three had PEEK implants and three had titanium. Gross total resection achieved in all cases. No intraoperative implant placement problems, infections or CSF leak. At latest follow-up all have normal optic-nerve function, one persistent mild proptosis and one mild vertical diplopia. Overall cosmetic outcome was good.

Conclusion: Meticulous preoperative planning using 3D printed models, custom pre-molded rigid implants for reconstruction and multidisciplinary skull base team provided radical resection of sphenoorbital hyperostotic tumors with minimal morbidity, excellent functional, oncological and cosmetic outcomes in this series. The 3D printed models have enabled detailed pre-operative planning and are well suited to skull base pathology.