Removal of giant intraosseous meningioma followed by cranioplasty using a custom-made bioceramic implant: case report

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Intraosseous meningioma of the chordoid type is a rare clinical entity. Radical surgical removal and subsequent cranioplasty is the treatment of choice. Here, the authors report a severe case involving more than 70% of the calvarial surface area, which was removed and repaired using a prefabricated custom-made, titanium-reinforced, bioceramic implant and bone-cutting guides. Tumor removal and good esthetic outcome were achieved, along with a 17.1% increase of intracranial volume. Bioceramic implants have shown promising initial results and may represent an important new tool in the surgeon’s armamentarium.

Article Information

Correspondence Jimmy Sundblom: Uppsala University Hospital, Uppsala, Sweden. jimmy.sundblom@neuro.uu.se.

INCLUDE WHEN CITING Published online September 14, 2018; DOI: 10.3171/2018.4.JNS1850.

Disclosures Dr. Ryttlefors received a lecture honorarium from OssDsign during 2016.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: Preoperative image showing severe bulging of frontal bone and the whole of the right calvaria. B: 6 months postoperatively, a good cosmetic outcome is seen. Note the slight outline of the cranioplasty segments, probably due to the necessary removal of periosteum. In our experience, this outline will disappear during the 1st year after surgery. Figure is available in color online only.

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    A: Preoperative MRI showing extensive spiculated involvement of bone, dural enhancement, and soft-tissue invasion on the right side. Also, note smaller intradural meningiomas of the lateral sphenoid wing and confluence of sinuses. B: Postoperative MRI showing removal of tumor and increase of intracranial volume and ventricle size. Contralateral meningioma was unchanged. C: Preoperative CT (upper) showing extension of bone involvement. Postoperative CT (lower) showing cranioplasty in place.

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    A: 3D renderings of the patient’s skull at presentation. B: Planned cranioplasty design.

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    A: Planned incision lines drawn on a model skull. B: Intraoperative photograph showing bicoronal incision. Intact periosteum on the left side was used to cover frontal sinus. C: After removal of frontal bone bilaterally, fat tissue packing of frontal sinus is seen as well as temporary bilateral duraplasty with DuRepair. D: Removed frontal part of intraosseous meningioma. E: A bone-cutting guide was used to trim edges of bone for the intended cranioplasty. F: Primary cranioplasty with custom-made bioceramic implants. Figure is available in color online only.

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    Photomicrographs showing histopathological findings. A: Predominant chordoid pattern in the tumor specimen from the secondary surgery. H & E. B: In contrast, meningioma cells without atypia from right-sided supraorbital intracranial meningioma. H & E. C: Vacuolated tumor cells in the mucin-rich extracellular matrix characteristic of chordoid meningioma. Alcian blue–periodic acid–Schiff staining. D: Extracranial muscle tissue infiltrated by the tumor. H & E. E: MIB-1 staining from the first surgery (Ki-67). F: MIB-1 staining from the second surgery (Ki-67). Original magnification ×200 in all panels. Figure is available in color online only.

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