A Case-Series of Solitary Skull Neoplastic Lesions Treated with En-Block Resection and Complex Cranioplasty

Background and aims: Tumors involving the calvarium but extending into the adjacent scalp layers and/or the underlying dura and brain are technically challenging to treat. Patients often present late in the course of disease which results in either irresectable tumor configurations or ? if at all feasible- the need for complex resections, the latter involving allograft cranioplasty and duraplasty sometimes in combination with skin grafting to repair surgical defects. This multidisciplinary study evaluates the outcome of complex single stage resections treated with allograft cranioplasty and duraplasty some of which required a combination of same-session soft tissue coverage by plastic surgery. Methods: We analyzed the management of 17 such complex cases, including 11 patients with metastases secondary to primary malignancies, 2 cases of meningiomas as well as single cases of squamous cell carcinoma, sarcoma, epidermoid and hemangioma. All patients underwent single step tumor resection craniectomy repaired with cranioplasty/duraplasty using a titanium mesh which was augmented by methyl methacrylate. Closure ensued with or without soft tissue coverage by flaps and/or grafts. Multidisciplinary follow-up was pursued to monitor local recurrence and potential wound complications. Results: Outcome analysis revealed excellent results without wound complications or local recurrence and short hospital stay following the procedure. Conclusion: Single step en-bloc resection of complex skull lesions with same-session cranioplasty may be an effective option to manage patients with solitary skull tumors whether benign, primary malignant or secondary malignant.