Three-dimensional virtual planning and custom polyetheretherketone reconstruction for spheno-orbital meningiomas: a case series and proposed new classification system.

Abstract

Spheno-orbital meningioma (SOM) resections pose significant reconstructive challenges. Presented here is a case series of orbital and functional outcomes using polyetheretherketone (PEEK) implants and cutting guides to describe a tertiary centre's practice of using custom reconstruction to assist in improving orbital symmetry with the aim of functional improvement in symptomatic diplopia. Between June 2020 and October 2023, 13 consecutive adult patients with SOM were managed surgically by resection and custom reconstruction. Retrospectively, for each patient, clinical data including Hertel difference (HD) and orbital volume difference (OVD, the comparison of affected and unaffected orbital volumes) were collected and compared preoperatively and postoperatively. The series had a mean follow-up of 21 months. Preoperatively, 10 patients had proptosis or diplopia, and nine patients had improvement postoperatively. The mean Hertel differences improved from 4.3 mm (range 0-7 mm) preoperatively to 2.1 mm (range 0-5) postoperatively (P = 0.01). The mean OVDs increased from 1.9 cm³ (range 0.3-4.1 cm³) preoperatively to 2.4 cm³ (range 0.3-4.8) postoperatively (P = 0.30). In the authors' experience, using PEEK for custom reconstruction is a safe and effective way to improve globe position, measurable using a Hertel exophthalmometer and visual symptoms. The authors aim to propose a classification system for surgical planning, particularly where there may be benefit in utilizing virtual planning and custom reconstruction for cases with extensive bone involvement.