Surgical removal of a skin cancer involving the superior sagittal sinus: gradual obstruction of the sinus using miniature tissue expanders

Abstract

An extensive basal cell carcinoma of the mid-parietal scalp penetrating the skull and invading the posterior third of the superior sagittal sinus was successfully treated in a 60-year-old man. This was accomplished by gradually obstructing the sinus over a period of five weeks unit it was possible to resect the tumor along with 15 cm of the sagittal sinus. Total obstruction of the sinus was achieved using two miniature tissue expanders surgically placed and affixed to the vessel. By gradual filling of the expanders, it was possible, after five weeks, to demonstrate angiographically that the sagittal sinus between the two tissue expanders was obliterated. The one piece resection included a wide margin of skin, bone, dura mater and sagittal sinus. The extensive defect of the dura mater was covered by a free fascia lata graft and the scalp defect by a visor bipedicled forehead flap. The forehead donor area was skin grafted. There were no complications during surgery and the patient recovered uneventfully. There has been no recurrence after one year.