Porous polyethylene implant reconstruction of the orbit after resection of spheno-orbital meningiomas: a novel technique.

BACKGROUND: Spheno-orbital meningiomas (SOM) are complex tumors involving the middle cranial fossa and orbit. Following resection of these tumors, reconstruction of the orbit can be challenging. Inadequate reconstruction may lead to cosmetic deformities and functional complications. OBJECTIVE: The development of a technique for orbital reconstruction which is technically straightforward, cost-effective, with an excellent functional and cosmetic outcome. TECHNIQUE: Twelve patients with SOM each underwent a modified orbital-zygomatic craniotomy with osteotomies based on individual tumor location. After tumor resection, the lateral orbit and orbital roof, where necessary, were reconstructed using a 1 mm porous polyethylene sheet, customized to reconstruct the bony anatomy of the lateral and superior orbit and secured with 1.5×4 mm titanium screws into the orbital roof and rim. RESULTS: All patients demonstrated stabilization or improvement of vision and satisfactory cosmetic outcomes. One complication (surgical site infection) was noted. Follow-up imaging was obtained at regular intervals. The resection cavity was easily visualized without interference from the implant in each case. One patient developed tumor recurrence requiring re-operation 20 months after the initial procedure. CONCLUSIONS: Use of a 1mm porous polyethylene sheet for reconstruction of the lateral orbit offers an excellent functional and cosmetic outcome, does not interfere with postoperative imaging, is technically straightforward, and is cost-effective.

Rehabilitation after cranial base surgery.

Recent advancements in skull base surgery to remove or diminish the size of cranial base tumors allow more to be done than ever before to preserve life for patients who have tumors in anatomic locations once considered unreachable without causing massive functional impairment or death. Nonetheless, the resulting outcome has a direct and serious impact on the quality of life of the patient. In this article on palliation, the authors focus on the rehabilitative techniques used in patients who have undergone extensive cranial base resection. These techniques can also be used to improve the life of patients who have not undergone surgery but suffer from poor quality of life because of the natural growth of the tumor.

[Skull base reconstruction and rehabilitation].

OBJECTIVE: To review our experience with skull base reconstruction and rehabilitation. METHOD: The clinical data of 30 patients with skull base reconstruction from 200 patients performed skull base surgery were retrospectively reviewed. Bone defect of skull base were repaired in 20 patients and dura defect in 6 patients and soft tissue defect in infratemporal fossa in 8 patients. RESULT: Postoperatively there were transient cerebrospinal leakage in 3 patients, and non-symptom intracranial pneumatosis in 3 patients, and epidural hematoma in 1 patient, and meningitis in 1 patients. CONCLUSION: Immediate reconstruction of skull base with suitable material and surgical technique can prevente complications such as postoperative infection and cerebrospinal leakage brain hernation.

Health-related quality of life in patients with skull base tumours.

The objective of the investigation was to report on the health-related quality of life (HRQoL) of patients diagnosed with skull base tumours using the Short Form Health Survey questionnaire (SF-36). Those patients suffering with vestibular schwannoma were examined to determine the effect facial nerve function had on their quality of life. It took place at the tertiary referral centre at the Department of Clinical Neurosciences, Western General Hospital, Edinburgh. A prospective study of 70 consecutive patients was taken, who harboured the following tumours: 54 vestibular schwannomas, 13 meningiomas, two haemangioblastomas and one hypoglossal schwannoma. Patients were interviewed using the short form 36 (SF-36) questionnaire. Facial nerve function was assessed in those patients who had vestibular schwannomas. The entire cohort of live skull base patients were assessed after a median follow-up time of 38.4 months. Patients with vestibular schwannoma treated conservatively with interval MRI had a quality of life similar to t he normal population. Those who underwent surgery had a significant difference in two of the SF-36 domains. No statistically significant correlation was found at final assessment between the degree of facial nerve functioning and any of the domains of SF-36. Patients with non-vestibular tumours had an impaired HRQoL in seven of the eight domains. Patients with skull base tumours have a significant impairment of their HRQoL. A conservative policy of follow up with interval MRI for patients with small vestibular schwannomas may therefore be more appropriate to preserve their HRQoL. Facial nerve outcome has little influence on quality of life in vestibular schwannoma patients.

The realities of postoperative disability and the carer's burden.

Outcome after high-risk, complex neurosurgery for progressive skull base pathology, and its effect on carers, has been examined. Two different outcome measures were used. The Glasgow Outcome Score (GOS) assesses overall social capability and dependence of the patient, while the 36 item short-form health survey (SF-36), a generic quality of life measure, can be compared directly with the general population. Overall outcome using the GOS indicated a favourable outcome for 13 of the 17 patients studied. The SF-36 demonstrated that more than half the patients were functioning at a level below the accepted norm. The reasons for this discrepancy and the validity of outcome scales have been analysed. In addition, the effect upon carers, its relevance to assessment of outcome, and the need to involve potential carers in the process of informed consent was stated. Our conclusions are applicable throughout the surgical specialities, and especially to high-risk complex surgery.