Bifrontal Craniotomy for Resection of Recurrent Fibrous Dysplasia: 2-Dimensional Operative Video.

Abstract

Fibrous dysplasia, which causes tumor-like growth and weakening of the involved bone, may require neurosurgical intervention to achieve complete resection with subsequent reconstruction. The case described in this video involved a 31-yr-old woman with a history of fibrous dysplasia who had previously undergone extensive craniofacial fibrous dysplasia resection and vault reconstruction. She presented to the emergency department with 1 wk of fever, chills, headache, sinus pain, and proptosis of her right eye. On examination, she had left gaze palsy and diplopia on left lateral gaze. Magnetic resonance imaging (MRI) revealed a right frontal lobe parenchymal abscess and progression of her fibrous dysplasia. Blood cultures were obtained, and treatment with broad-spectrum antibiotics and antiepileptics was initiated. The patient underwent a bifrontal craniotomy with extended transbasal anterior skull base approach for the resection of recurrent fibrous dysplasia, evacuation of the cerebral abscess, and placement of an external ventriculostomy drain. She tolerated the procedure well and was discharged on postoperative day 6 with intravenous antibiotics. Postoperative computed tomography and MRI demonstrated excellent resection of the skull base fibrous dysplasia with placement of soft tissue and fat flap in the surgical defect, decrease of right-sided proptosis, and drainage of the right frontal parenchymal abscesses. Three months later, the patient underwent placement of a custom-made Medpor cranioplasty implant (Stryker, Kalamazoo, Michigan). At her last follow-up appointment, 14 mo after surgery, she had complete resolution of the diplopia and gaze palsy. Neuroimaging demonstrated a small residual of fibrous dysplasia on the left frontoethmoidal recess. The patient gave consent for publication.Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy027 {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Bifrontal Craniotomy for Resection of Recurrent Fibrous Dysplasia: 2-Dimensional Operative Video","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_sn3qh8og"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.