Clinical Scorecard: Three-Dimensional Printing Facilitated Cranio-Orbital Reconstruction Using Customized Polyetheretherketone Implants Following Benign Spheno-Orbital Tumor Resection

At a Glance

Key Highlights

• Rigid orbital reconstruction with customized PEEK implants prevents malalignment and pulsating eye bulb, preserving orbital volume and reducing exophthalmos.
• Preoperative virtual planning integrates CT, MRI, and PET imaging to define tumor and bone resection margins, enabling precise design of cutting guides and implants.
• Single-step surgical approach combining tumor resection and immediate cranio-orbital reconstruction using 3D printed patient-specific implants improves functional, visual, and aesthetic outcomes.

Guideline-Based Recommendations

Diagnosis

• Use thin-sliced 1 mm cranial CT, contrast-enhanced brain MRI, and optionally 68Ga-DOTATOC PET/CT for detailed tumor and bone margin delineation.
• Define tumor and safe skull resection margins collaboratively by neurosurgeons and maxillofacial surgeons using advanced planning software.

Management

• Perform single-stage microsurgical tumor resection and cranio-orbital reconstruction under general anesthesia.
• Utilize CAD/CAM designed PEEK patient-specific implants and cutting guides produced by 3D printing for precise reconstruction.
• Intraoperatively adapt implants as needed to accommodate actual resection margins.
• Verify extent of resection and implant placement with intraoperative imaging.

Monitoring & Follow-up

• Conduct postoperative cranial MRI or CT imaging on day one and at 3 to 6 months post-surgery.
• Perform regular ophthalmological examinations to assess visual function and monitor for exophthalmos.
• Calculate Exophthalmic Index preoperatively and postoperatively to evaluate orbital volume restoration.

Risks

• Potential deterioration of visual acuity due to optic nerve traction during surgery.
• Challenges in preoperative planning due to complex tumor margins and bone cuts.
• Possible need for intraoperative implant modification if resection margins differ from planned.

Patient & Prescribing Data

Eleven consecutive female patients aged 19–72 years with benign spheno-orbital tumors undergoing single-stage resection and reconstruction.

Majority presented with exophthalmos; some had prior resections, biopsies, or radiotherapy. Median surgery time was approximately 13 hours. Interdisciplinary surgical collaboration and advanced imaging guided personalized implant design and successful reconstruction.

Clinical Best Practices

• Engage an interdisciplinary skull base team including neurosurgeons and maxillofacial surgeons for optimal tumor control and reconstruction.
• Employ advanced imaging modalities and digital planning software for precise definition of tumor and bone resection margins.
• Use 3D printing at point of care for surgical planning models and patient-specific cutting guides and implants.
• Perform intraoperative imaging to confirm resection extent and implant positioning.
• Obtain informed consent and adhere to ethical standards including institutional and Helsinki declarations.

References

• Brainlab Elements software
• Formlabs Form 3B stereolithography printer
• Tutopatch dural replacement