Abstract
Treatment of a large, symptomatic skull metastasis requires surgical excision and in many cases postoperative radiation therapy. Immediate reconstruction of the skull for cerebral protection usually involves cranioplasty with titanium mesh and/or methyl methacrylate. Preoperative synthetic cranioplasty technology is yet to evolve sufficiently to allow computer-generated prostheses to precisely fit a defined craniectomy defect created at the time of tumor removal. We document the techniques used for simultaneous craniectomy and composite cranioplasty in the setting of a large occipital renal cell skull metastasis. Preoperative computed tomography (CT) and magnetic resonance (MR) imaging identified the pathological anatomy of an occipital skull metastasis presenting as an exophytic scalp mass. Preoperative angiography and embolization was performed followed by craniectomy in the semi-sitting position and composite cranioplasty using titanium mesh and methyl methacrylate. A series of steps in the surgical procedure are outlined to assist with safely and accurately performing the craniectomy and cranioplasty to guarantee the best surgical and cosmetic outcome. Postoperative CT imaging confirmed excellent contours of the cranioplasty. The method described herein allows for a single-step surgical procedure to excise a large skull metastasis and create a structurally sound and cosmetically acceptable composite cranioplasty. This method can also be used for the excision and repair of other skull tumors or anomalies requiring excision.
Highlights
Patients with early cranioplasties have been reported to demonstrate improvements in neurological function
The existing skull defects are routinely repaired with computer-generated cranioplasty implants
Excising a large, symptomatic skull lesion and creating a simultaneous cranioplasty with an appropriate shape and contour is problematic for surgeons
Summary
Patients with early cranioplasties have been reported to demonstrate improvements in neurological function. Excising a large, symptomatic skull lesion and creating a simultaneous cranioplasty with an appropriate shape and contour is problematic for surgeons. We describe the technique of in situ cranioplasty used for the excision of a large occipital renal cell skull metastasis and point out the sequence of steps that may be used to ensure a safe excision and structurally sound and cosmetically acceptable cranioplasty performed at the time of tumor removal. A large piece of titanium mesh was molded and cut to the shape of the drilled down tumor-involved skull. Postoperative MR and CT imaging revealed an appropriate contour of the cranioplasty and gross total tumor excision (Figure 4). A: Sagittal and B: coronal postcontrast T1 weighted postoperative MR image showing gross total resection of the metastatic lesion. D: The different areas of bone involved in the cranioplasty are shown color coded based on the image in C
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
