Reconstruction of Sphenoid Wing Dysplasia with Pulsating Exophthalmos in a Case of Neurofibromatosis Type 1 Supported by Intraoperative Navigation Using a New Skull Reference System

Reinhard E. Friedrich; Max Heiland; Uwe Kehler; Rainer Schmelzle

doi:10.1055/s-2004-817697

Skull Base, Table of Contents

Skull Base 2003; 13(4): 211-216
DOI: 10.1055/s-2004-817697

CASE REPORT

Reconstruction of Sphenoid Wing Dysplasia with Pulsating Exophthalmos in a Case of Neurofibromatosis Type 1 Supported by Intraoperative Navigation Using a New Skull Reference System

Reinhard E. Friedrich¹ , Max Heiland¹ , Uwe Kehler² , Rainer Schmelzle¹

¹Oral and Maxillofacial Surgery (Nordwestdeutsche Kieferklinik), University Hospital Hamburg-Eppendorf, Hamburg, Germany
²Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany

Abstract

ABSTRACT

A patient with neurofibromatosis type 1 had pulsating exophthalmos of the right eye with diplopia resulting from severe dysplasia of the sphenoid bone and consecutive herniation of the right temporal lobe. The right orbital tectum was reconstructed with titanium mesh and iliac spongiosa via a lateral orbitotomy using intraoperative navigation. For intraoperative referencing a cortical fixed-reference system and a skin scanning laser device were used. Postoperatively, the diplopia was reduced, but the patient asked for further treatment and the procedure was repeated 6 months later. Intraoperatively, the previously implanted titanium mesh was deformed and most of the transplanted bone was resorbed, probably because of pressure. A more extended mesh was implanted and iliac spongiosa was placed on both sides. Intraoperative navigation was used during both procedures. The adverse effects of diplopia were minimized and follow-up computed tomography after seven months confirmed that the bone graft was in place.

KEYWORDS

Neurofibromatosis type 1 - sphenoid dysplasia - intraoperative navigation

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References

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