Cranial Reconstruction for Infiltrative Meningioma Using ⁶⁸Ga-Dotatate PET/CT and IPS Casedesigner: A Case Series

Introduction: Meningioma with bone involvement presents challenges for complete resection and cranial reconstruction. ⁶⁸Ga-DOTATATE PET/CT has emerged as an excellent modality for localizing invasive meningiomas due to molecular interaction with somatostatin receptor-2. We present a novel technique to design 3D-printed artificial cranioplasty, utilizing combined fine-slice CT, MRI, and ⁶⁸Ga-DOTATATE PET/CT with IPS CaseDesigner software.

Methods: Three patients with invasive bone meningiomas were retrospectively identified. For each patient, the proposed protocol combines CT, MRI, and ⁶⁸Ga-DOTATATE PET/CT imaging to generate a 3D cranial reconstruction within the KLS Martin-IPS CaseDesigner software. Subsequently, the virtual rendering is used to manufacture a customized polyetheretherketone (PEEK) implant, along with a guiding component, which ensures precise delineation of surgical borders before craniectomy. Lastly, following tumor and bone resection, cranioplasty with the customized implant is performed using standard techniques.

Results: The described preoperative cranioplasty design protocol was performed for each patient. Tumor invasion was visualized using ⁶⁸Ga-DOTATATE PET/CT. Patient 1 presented with a recurrent right frontal meningioma with invasion into anterior skull base. In this case, IPS CaseDesigner was used to create a mirror-image PEEK implant for the left orbit and affected cranium. Patients 2 and 3 had intraosseous meningiomas invading the frontal bone; customized PEEK implants were tailored to the side of the planned craniectomy for both patients and were successfully placed without complication. Postoperatively, all patients remained neurologically intact and were discharged without complications. In all patients, the PEEK implants exhibited appropriate cranial continuity and integrity.

Conclusion: ⁶⁸Ga-DOTATATE PET/CT has high sensitivity and specificity for detecting meningiomas during preoperative planning, particularly when the tumor involves bone. IPS CaseDesigner demonstrates excellent utility for planning and constructing customized cranioplasties tailored to each patient for skull reconstruction ([Figs. 1] [2] [3] [4]).

Fig. 1 Preoperative imaging of patient 1. (A, B) Contrast-enhancing T1-weighted MRI in coronal and sagittal planes showing a large sclerotic lesion (blue arrow) within the anterior frontal bone, associated with right frontal lobe dural thickening up to 7 mm (red arrow). (C, D) Bone window CT showing the bony lesion in the anterior calvarium (blue asterisk), associated with lobulated material filling the frontal sinuses (red asterisk).

Fig. 2 Preoperative ⁶⁸Ga-DOTATATE PET/CT of patient 1 showing an intensely avid lesion centered in the frontal bone and extending into the dural surface on the right frontal lobe. Prominent hyperostotic changes are also observed along the roof of the right orbit, right lamina papyracea and crista galli.

Fig. 3 Preoperative cranioplasty planning of patient 1 using fine-cut CT (A, B) and ⁶⁸Ga-DOTATATE PET/CT (C, D). The proposed implant is shown in green.

Fig. 4 Intraoperative photos of patient 1. (A) Craniotomy planning using the template guide. (B) Surgical field after bifrontal craniotomy, tumor resection, dural reconstruction, frontal sinusotomy and cranialization, drilling of right orbital roof and midline nasal bone, removal of crista galli, anterior ethmoid air cells, and lamina papyracea. (C) KLS custom-made cranioplasty composed of two components fixed with screw and plates. (D) Final cranial reconstruction.

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Artikel online veröffentlicht:
07. Februar 2025