Immediate PEEK patient-specific cranioplasty in sphenoid wing meningioma resection: 10-year clinical outcomes of a contemporary approach to complex orbital reconstruction

Abstract

Sphenoid wing meningiomas are characterized by bony hyperostosis and dural invasion. Surgical resection is often extensive, giving rise to complex orbital defects. Orbital reconstruction is associated with improved structural and functional outcomes. Patient-specific cranioplasty implants facilitate the accurate orbital volume reconstruction, with polyetheretherketone (PEEK) exhibiting advantageous material properties. This retrospective case series evaluates the clinical outcomes of immediate PEEK-implant reconstruction of complex orbital defects in patients undergoing sphenoid wing meningioma resection via a combined anterolateral approach between 2015 and 2024. Outcome measures include complications, re-operations, long-term implant retention and visual outcomes. A total of 25 patients underwent follow-up of 43.8 (31.4) months. Emergency re-operations were performed in 16.0 % of cases, including CSF leak repair (8.0%), extradural haematoma evacuation (4.0%) and orbital exploration (4.0%), all involving immediate implant reinsertion. No implant infection cases were reported. The exophthalmic index was reduced from 1.36 (0.27) to 1.06 (0.08) at 1year post-operatively (Z = 4.5, p < 0.01). Visual acuity was preserved in 88.0%. This study highlights the immediate PEEK-implant cranioplasty via the combined anterolateral approach as a valid reconstructive option for complex orbital defects in sphenoid wing meningioma patients. Prospective comparative studies are warranted to determine the ideal method of reconstruction in this challenging patient population.

Keywords: Cranioplasty; Meningioma; PEEK-Implant; Reconstruction; Sphenoid-wing.