SPLIT CALVARIAL BONE-GRAFT IN CRANIO-ORBITAL SPHENOID WING RECONSTRUCTION

Sphenoid wing defects of the posterior orbit and frontal and middle cr anial fossae, secondary to tumor ablation, create difficulties in orbi tal and cranial base reconstruction. Autogenous split calvarial bone g rafts harvested at the time of neurosurgical tumor ablation were used to reconstruct sphenoid wing defects in nine patients between July 198 3 and January 1993. Meningioma is the most common tumor resected in th is series, followed by fibrous dysplasia. Patient follow-up ranged fro m 1 to 5 years with a mean of 3 years. Calvarial bone grafting was per formed to restore continuity of frontal bone, supraorbital ridge, orbi tal roof, and lateral wall and floor. All patients demonstrating propt osis showed either complete resolution or significant improvement post operatively by exophthalmometry. Postoperative pulsatile exophthalmos occurred transiently in one patient but resolved spontaneously. Postop erative diplopia occurred in two patients, which subsequently resolved within 6 weeks. There were no incidents of postoperative osteomyeliti s or bone graft loss within the reported postoperative period. Convent ional and three-dimensional computed axial tomographic scans did not d emonstrate bony resorption resulting in structural instability in any of the cases with this reconstructive method.