STRATEGY OF CRANIOFACIAL RECONSTRUCTION AFTER RESECTION OF SPHENO-ORBITAL EN PLAQUE MENINGIOMAS

Surgical resection of spheno-orbital ''en plaque'' meningiomas should be as complete as possible to prevent tumor recurrence and therefore r equires a bone reconstruction. We report a series of 20 patients opera ted on for spheno-orbital ''en plaque'' meningioma between 1981 and 19 93. The surgical treatment included a resection of the involved dura a nd a wide resection of tumoral bone using a fronto-temporal craniotomy extended to the orbitozygomaticomalar bone ridge. The craniofacial re construction was performed in the same operative procedure using iliac bone autograft in 11 patients, internal cortical bone from the bone f lap in 8 patients, and a coral graft in 1 patient. The cosmetic result was scored according to the following criteria: superior frontal para lysis, appearance of the orbitomalar bone ridge, shape of the external temporal fossa, and projection of the eyeballs. The cosmetic result w as scored as excellent or good in 17 patients, average in 2 patients, and poor in 1 patient. The iliac bone autograft appeared to be the bes t material for craniofacial reconstruction because it could be modeled easily to the desired shape. However, the reconstruction technique wa s modified as necessary according to the extent of tumor removal, clin ical presentation, and age of the patient.