En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach

Sabine A. Egeler, A. Johnson, Winona W. Wu, A. Bucknor, Yen-Chou Chen, Ahmed B. Bayoumi, E. Kasper
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Abstract

Abstract Background This study analyzes the surgical outcomes for single setting surgeries involving en-bloc solitary calvarial tumor resection in combination with three-layered reconstruction, presenting a novel planning algorithm. Methods Data were retrieved for all patients undergoing single-stage tumor excision, using our novel three-layered reconstructive approach (duraplasty, cranioplasty, and soft tissue reconstruction) between 2005 and 2017 at a single tertiary hospital center. Patients ≥18 years with a Karnofsky Performance score (KPS) >70 and a life expectancy of > 2 months were included. Patient characteristics, surgical specifics, histological diagnoses, outcomes, and complications were reviewed. Results Eighteen single-staged excisions and three-layered reconstructions were performed. Seven patients presented with primary tumors and 11 patients with metastases. Mean age was 62 years. Mean follow-up time was 39 months. Primary closure was used in 12 of 18 patients, microvascular free flap with skin grafting in 4 of 18, and local advancement or rotational flap in 2 of 18. Two compromised free flaps were revised. There was no flap necrosis, skin graft failure, or wound infection observed in this series. Neurosurgical complications included two cases with seizures, one sublesional intraparenchymal hematoma, one adjacent parenchymal infarct, one case of delayed postradiation cerebrospinal fluid leakage, and one case of subdural hemorrhage. Conclusion En-bloc excision followed by three-layered reconstruction is a feasible and often suitable single-stage technique for complex solitary metastasis or primary calvarial tumors, which historically have been challenging to treat. It can offer an alternative approach to primary and metastatic calvarial tumors other than palliative treatment or hospice care.
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孤立性颅骨肿瘤的整体切除:一种算法重建方法
摘要背景 本研究分析了包括整体孤立性颅骨肿瘤切除和三层重建的单一设置手术的手术结果,提出了一种新的规划算法。方法 2005年至2017年间,在一家三级医院中心,使用我们新颖的三层重建方法(硬脑膜成形术、颅骨成形术和软组织重建),检索了所有接受单期肿瘤切除的患者的数据。Karnofsky性能评分(KPS)>70且预期寿命≥18岁的患者 > 包括2个月。回顾了患者特征、手术细节、组织学诊断、结果和并发症。后果 进行了18次单阶段切除和三层重建。7例为原发性肿瘤,11例为转移性肿瘤。平均年龄62岁。平均随访时间39个月。18例患者中有12例采用一期闭合术,18例中有4例采用带皮片的微血管游离皮瓣,18例例中有2例采用局部推进或旋转皮瓣。修正了两个受损的游离皮瓣。该系列中未观察到皮瓣坏死、皮肤移植失败或伤口感染。神经外科并发症包括2例癫痫发作,1例脑实质内亚段血肿,1例邻近脑实质梗死,1例延迟性放射线后脑脊液渗漏,1例硬膜下出血。结论 对于复杂的孤立性转移或原发性颅骨肿瘤,整体切除后三层重建是一种可行且通常适合的单阶段技术,这在历史上一直很难治疗。它可以为原发性和转移性颅骨肿瘤提供一种替代方法,而不是姑息治疗或临终关怀。
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14 weeks
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