COMPOSITE CUSTOM-MADE BONE GRAFTS (SMARTBONE® ON DEMAND™) FOR A LARGE SPHENO-ORBITAL RECONSTRUCTION

The treatment of anterior and lateral skull base tumors has always constituted a complex surgical challenge: extensive bony demolitions produce aesthetic deformities that need accurate reconstructions. Indeed, highly destructive procedures increased the need to introduce new reconstructive techniques. Wide defects, e.g. those involving more than a single orbital wall, have to be reconstructed with solid tissues such as autologus grafts or alloplastic materials. Surgical visual limits may reduce the possibility to properly repair the three-dimensional bony architecture of the craniofacial skeleton: because of the nonlinear nature of the bone in the craniofacial skeleton, even small degrees of error can lead to poor outcomes. Here we investigated the innovative application of custom-made bone grafts in a case of skull base reconstructive surgery, a technique that is not previously reported. Innovations applied to this case were multiple: basing on high resolution patient’s CT scans, virtual surgery and computer-aided design were used to plan resection; contralateral disease-free skull base was used as a reference and mirroring technique was used to create the ideal grafts, which were then manufactured accordingly using the new composite custom-made bone grafts (SmartBone® on Demand™). SmartBone® is shaping resistant and offers high tenacity to screws and surgical fixation manoeuvres, because it is produced by combining bovine mineral bone structures with biopolymers and cell nutrients (polysaccharides). The patient underwent resection of a meningioma in the spheno-orbital-temporal region. The neurosurgeon resected the meningeal involved district, which was then reconstructed with a collagenous membrane. SmartBone® on Demand™ were then very precisely grafted into destination site. During follow-up, nor cerebrospinal fluid leakage nor intracranial infection were registered. Postoperative CT scans showed excellent stability and integration of all bone grafts; postoperative morphological results are satisfactory. Outcomes confirm the high reliability and accuracy of virtual surgical planning and grafts design, which, together with SmartBone® high performances, allow producing very precise and stable custom-made grafts and, finally, addressing the previously unmet needs in skull base reconstructive surgery.