Extrusion of Intracranial Tumor Mass—A Rare Phenomenon

Abstract

Introduction: The extrusion of intramedullary spinal cord tumor is a well known fact. Charles Elsberg described a two-staged approach for the removal of these tumors. In the first stage, a posterior midline myelotomy was performed overlying the tumor followed by a nondural closure. During the second surgery, 7 days later, the extruded tumor, through the myelotomy, was removed. However, an extrusion of the intracranial tumor mass has never been reported. We report a rare case wherein there was extrusion of the intracranial tumor after the first surgery. Case Report: A 19-year-old male presented with chief complaints of headache, vomiting on and off, and blurring of vision in both the eyes since 2 months. The patient also complained of swelling over the right side of the skull. Radiological imaging was suggestive of a heterogeneous contrast-enhancing right parietal bone osteolytic lesion with subgaleal and intracranial extension. Right parietal craniectomy and a subtotal removal of the mass was done. Due to excessive blood loss and hemodynamic instability, it was decided to do a two-stage surgery. After 7 days, during the second operation, the brain had extruded the residual mass, which was lying just beneath the skin flap. A complete excision of the tumor with duraplasty using tensor fascia latae was performed. Conclusion: In some cases, two-stage surgery for the resection of large intracranial tumors is beneficial. However, two-stage surgery should only be undertaken as a damage control measure and not as a routine standard of care.