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.
Keywords
tumor - cranioplasty - scalp reconstruction
