En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach
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 patie...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Georg Thieme Verlag KG
2019-01-01
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| Series: | Journal of Reconstructive Microsurgery Open |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1678703 |
| _version_ | 1818912160619692032 |
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| author | Sabine A. Egeler Anna Rose Johnson Winona Wu Alexandra Bucknor Yen-Chou Chen Ahmed B. Bayoumi Ekkehard M. Kasper |
| author_facet | Sabine A. Egeler Anna Rose Johnson Winona Wu Alexandra Bucknor Yen-Chou Chen Ahmed B. Bayoumi Ekkehard M. Kasper |
| author_sort | Sabine A. Egeler |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-19T23:10:11Z |
| format | Article |
| id | doaj.art-15dfbe85eafd46efaec93f3f3a4e709d |
| institution | Directory Open Access Journal |
| issn | 2377-0813 2377-0821 |
| language | English |
| last_indexed | 2024-12-19T23:10:11Z |
| publishDate | 2019-01-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Journal of Reconstructive Microsurgery Open |
| spelling | doaj.art-15dfbe85eafd46efaec93f3f3a4e709d2022-12-21T20:02:15ZengGeorg Thieme Verlag KGJournal of Reconstructive Microsurgery Open2377-08132377-08212019-01-010401e14e2310.1055/s-0039-1678703En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive ApproachSabine A. Egeler0Anna Rose Johnson1Winona Wu2Alexandra Bucknor3Yen-Chou Chen4Ahmed B. Bayoumi5Ekkehard M. Kasper6Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsDivision of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsDivision of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsDivision of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsDivision of Neurosurgery, Hamilton General Hospital, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, OntarioDepartment of Neurosurgery, Bahcesehir University, Bahcesehir, TurkeyDivision of Neurosurgery, Hamilton General Hospital, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, OntarioAbstract 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1678703tumorcranioplastyscalp reconstruction |
| spellingShingle | Sabine A. Egeler Anna Rose Johnson Winona Wu Alexandra Bucknor Yen-Chou Chen Ahmed B. Bayoumi Ekkehard M. Kasper En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach Journal of Reconstructive Microsurgery Open tumor cranioplasty scalp reconstruction |
| title | En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach |
| title_full | En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach |
| title_fullStr | En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach |
| title_full_unstemmed | En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach |
| title_short | En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach |
| title_sort | en bloc resection of solitary cranial tumors an algorithmic reconstructive approach |
| topic | tumor cranioplasty scalp reconstruction |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1678703 |
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