Improvement of reconstructive surgical operations with closure of skull tissue defects in primary malignant tumors with intra-extracranial and extra-intracranial localization

Abstract

Objective ‒ to improve reconstructive and plastic methods of treatment of patients with malignant tumors that spread beyond the brain skull to ensure a decent quality of life.Materials and methods. The results of a comprehensive clinical examination and surgical treatment (with a reconstructive component) of 21 patients with scalp and skull tissue defects operated on in the extracerebral tumor clinic of Romodanov Institute of Neurosurgery of NAMS of Ukraine in the period from 2018 to 2021. There were 9 women and 12 men among the patients. The age of the patients is from 36 to 80 years old. All patients underwent clinical, neurological and instrumental examinations. The diagnosis was verified by the results of histopathomorphological examination. Statistical methods (discriminant analysis (MANOVA)) were used for data processing. Statistical significance was tested using the Pearson test (χ²).Results. The patients were divided into two groups. The main group (n=16) – operated on using adapted patented plastic techniques that take into account the optimal angle of direction of stress vectors in the tissue of skin-aponeurotic flaps in the postoperative period during stress relaxation. The comparison group was made up of 5 people operated on using traditional methods of mobilization and fixation of skin-aponeurotic flaps. Using the patient’s own tissues is the most reliable and effective method of cosmetic restoration of the head after radical treatment for locally advanced tumors. Active tactics (postoperative monitoring of the flap) make it possible to detect blood circulation disorders in the transplanted tissues at an early stage and to carry out a timely revision of the anastomoses. Performing simultaneous reconstructive operations is an integral part of complex treatment of patients with malignant tumors, expands the indications for performing gentle operations, allows to obtain «excellent» and «good» functional and aesthetic results in 85 % of cases. Simultaneous microsurgical reconstructive operations are possible in patients after complex treatment, although the frequency of thrombotic complications in this group was higher (12.5 %) than in the comparison group (7.5 %).Conclusions. The perspective of plastic-reconstructive replacement of defects for clinical application has been proven and the method has been improved using the latest technologies.Key words: malignant tumors; intracranial/extracranial spread; surgical treatment; reconstruction; quality of life.