Introduction: Reconstruction of pterional and temporal defects after frontotemporal (FT) and orbitozygomatic (OZ) craniotomy is important for maintaining functional restoration and cosmesis. To describe our experience and cosmetic results with pterional reconstruction after FT and OZ craniotomy with the Medpor Titan (titanium mesh embedded in porous polyethylene) implant.
Methods: Ninety-eight consecutive patients underwent reconstruction of pterional and temporal defects after FT and OZ craniotomy using the Medpor Titan implant. The implant was shaped to cover the pterional defect and secured to the bone flap with titanium screws. The patients were evaluated for temporalis symmetry and orbital symmetry by both the surgeon and patient, and were surveyed for overall cosmetic satisfaction at the 3 month follow-up visit.
Results: Of 90 patients who were surveyed at the three month follow-up visit, 89 patients (98.9%) were satisfied with their cosmetic result and did not notice any appreciable temporalis asymmetry. All had orbital symmetry (100%). One patient had a delayed wound infection and subsequent bone flap infection that required removal of the implant. One patient developed a severe inflammatory reaction requiring explantation of the implant. Of 90 patients who underwent cosmetic assessment at the 3 month follow-up appointment, temporalis asymmetry was noticed subjectively by three patients and noted in 7 patients by the surgeon. Orbital asymmetry was not noticed in any cases by either surgeon or patient. Overall patient satisfaction was found in 89 of 90 patients (98.9%).
Conclusions: Our technique using the Medpor Titan implant is a fast and effective method for pterional reconstruction after FT and OZ craniotomy with excellent cosmetic results and patient satisfaction. The implant combines the advantages of both porous polyethylene and titanium mesh, particularly its ease of shaping without sharp edges, structural support and coverage of large cranial defects, relatively lower cost, and porosity for tissue ingrowth.
Patient Care: The technique we use by utilizing the Medpor Titan implant is a fast and effective method for pterional reconstruction after FT and OZ craniotomy with excellent cosmetic results and patient satisfaction. In addition it is significantly less expensive than other possible reconstructive implants.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe different methods used for reconstruction of pterional defects and frontotemporal or orbitozygomatic craniotomy of 2) Discuss the advantages and disadvantages of these various methods and 3) Discuss how an implant made of titanium mesh embedded in porous polyethylene can provide satisfactory cosmetic results at a lower cost