CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2019; 04(01): e14-e23
DOI: 10.1055/s-0039-1678703
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach

Sabine A. Egeler
1  Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Anna Rose Johnson
1  Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Winona Wu
1  Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Alexandra Bucknor
1  Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Yen-Chou Chen
2  Division of Neurosurgery, Hamilton General Hospital, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario
,
Ahmed B. Bayoumi
3  Department of Neurosurgery, Bahcesehir University, Bahcesehir, Turkey
,
Ekkehard M. Kasper
2  Division of Neurosurgery, Hamilton General Hospital, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario
› Author Affiliations
Further Information

Publication History

05 March 2018

27 November 2018

Publication Date:
28 February 2019 (online)

  

Abstract

Background This study analyzes the surgical outcomes for single setting surgeries involving en-bloc solitary calvarial tumor resection in combination with three-layered reconstruction, presenting a novel planning algorithm.

Methods Data were retrieved for all patients undergoing single-stage tumor excision, using our novel three-layered reconstructive approach (duraplasty, cranioplasty, and soft tissue reconstruction) between 2005 and 2017 at a single tertiary hospital center. Patients ≥18 years with a Karnofsky Performance score (KPS) >70 and a life expectancy of > 2 months were included. Patient characteristics, surgical specifics, histological diagnoses, outcomes, and complications were reviewed.

Results Eighteen single-staged excisions and three-layered reconstructions were performed. Seven patients presented with primary tumors and 11 patients with metastases. Mean age was 62 years. Mean follow-up time was 39 months. Primary closure was used in 12 of 18 patients, microvascular free flap with skin grafting in 4 of 18, and local advancement or rotational flap in 2 of 18. Two compromised free flaps were revised. There was no flap necrosis, skin graft failure, or wound infection observed in this series. Neurosurgical complications included two cases with seizures, one sublesional intraparenchymal hematoma, one adjacent parenchymal infarct, one case of delayed postradiation cerebrospinal fluid leakage, and one case of subdural hemorrhage.

Conclusion En-bloc excision followed by three-layered reconstruction is a feasible and often suitable single-stage technique for complex solitary metastasis or primary calvarial tumors, which historically have been challenging to treat. It can offer an alternative approach to primary and metastatic calvarial tumors other than palliative treatment or hospice care.