2025 Proffered Presentations
S329: CRANIAL RECONSTRUCTION FOR INFILTRATIVE MENINGIOMA USING 68GA-DOTATATE PET/CT AND IPS CASEDESIGNER®: A CASE SERIES
Connor C Jacob, MS; Ludovica Pasquini, MD; Daniel M Prevedello, MD; The Ohio State University
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.
CONCLUSIONS: 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.
Image 1: Preoperative imaging of patient 1. A) and 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) and D) Bone window CT showing the bony lesion in the anterior calvarium (blue asterisk), associated with lobulated material filling the frontal sinuses (red asterisk).
Image 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.
Image 3: Preoperative cranioplasty planning of patient 1 using fine-cuts CT (A – B) and 68Ga-DOTATATE PET/CT (C – D). In green the proposed implant.
Image 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.