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Intraoperative Extracorporeal Irradiation for the Treatment of the Meningioma-Infiltrated Calvarium.

Kerr EE, Fragoso R, Schrot RJ, Shahlaie K - J Neurol Surg Rep (2015)

Bottom Line: Design, Setting, and Participant A 37-year-old woman with persistent chronic headaches was found to have an anterior skull base meningioma with extension into the forehead frontal bone.Main Outcome Measures and Results Twenty-nine months postoperatively, the patient had an excellent cosmetic outcome with no radiographic evidence of tumor recurrence or significant bone flap resorption.Conclusion Intraoperative extracorporeal irradiation of tumorous calvaria during meningioma surgery is an effective, logistically feasible treatment option to achieve local tumor control and excellent cosmetic outcome.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States.

ABSTRACT
Objectives Complete removal of infiltrated bone is required to achieve a Simpson Grade 1 meningioma resection. Reconstruction of the resulting bone defect is typically achieved with a nonnative implant that can result in poor cosmesis, foreign body reaction, or infection. Extracorporeal irradiation and reimplantation of tumorous bone has been used for limb-sparing surgery with excellent results, but this treatment option is not routinely considered in meningioma surgery. We present a case of anterior fossa meningioma with tumorous overlying calvarium that was successfully managed with intraoperative extracorporeal irradiation and reimplantation. Design, Setting, and Participant A 37-year-old woman with persistent chronic headaches was found to have an anterior skull base meningioma with extension into the forehead frontal bone. Concurrently with mass resection, the bone flap was irradiated intraoperatively with 120 Gy. After resection of the tumor, the bone flap was replaced in its native position. Main Outcome Measures and Results Twenty-nine months postoperatively, the patient had an excellent cosmetic outcome with no radiographic evidence of tumor recurrence or significant bone flap resorption. Conclusion Intraoperative extracorporeal irradiation of tumorous calvaria during meningioma surgery is an effective, logistically feasible treatment option to achieve local tumor control and excellent cosmetic outcome.

No MeSH data available.


Related in: MedlinePlus

(A) Three-dimensional and (B) axial computed tomography scans 19 months after surgery, demonstrating feathering of bone edges with preservation of normal contours.
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FI140060-4: (A) Three-dimensional and (B) axial computed tomography scans 19 months after surgery, demonstrating feathering of bone edges with preservation of normal contours.

Mentions: The patient's postoperative course was uneventful, and she was discharged home 3 days after surgery. The final histopathologic analysis of the mass was consistent with a World Health Organization grade 1 meningioma. She was seen 10 days postoperatively for a wound check and skin staple removal, at which time she had a normal forehead contour with no palpable step-offs. She was seen again at 3, 6, 12, 19, and 29 months after surgery, with serial imaging and repeat clinical examination. Her cosmetic outcome was excellent throughout the follow-up period (Fig. 3), and her postoperative imaging demonstrated radiodense feathering of the kerf edges suggestive of fibrous union (Fig. 4); there was no evidence of tumor recurrence in the bone flap. Contrast-enhanced magnetic resonance imaging obtained preoperatively and 29 months postoperatively demonstrates absence of dural enhancement and expansion of the cerebrum into the space previously occupied by tumorous bone (Fig. 5).


Intraoperative Extracorporeal Irradiation for the Treatment of the Meningioma-Infiltrated Calvarium.

Kerr EE, Fragoso R, Schrot RJ, Shahlaie K - J Neurol Surg Rep (2015)

(A) Three-dimensional and (B) axial computed tomography scans 19 months after surgery, demonstrating feathering of bone edges with preservation of normal contours.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4520997&req=5

FI140060-4: (A) Three-dimensional and (B) axial computed tomography scans 19 months after surgery, demonstrating feathering of bone edges with preservation of normal contours.
Mentions: The patient's postoperative course was uneventful, and she was discharged home 3 days after surgery. The final histopathologic analysis of the mass was consistent with a World Health Organization grade 1 meningioma. She was seen 10 days postoperatively for a wound check and skin staple removal, at which time she had a normal forehead contour with no palpable step-offs. She was seen again at 3, 6, 12, 19, and 29 months after surgery, with serial imaging and repeat clinical examination. Her cosmetic outcome was excellent throughout the follow-up period (Fig. 3), and her postoperative imaging demonstrated radiodense feathering of the kerf edges suggestive of fibrous union (Fig. 4); there was no evidence of tumor recurrence in the bone flap. Contrast-enhanced magnetic resonance imaging obtained preoperatively and 29 months postoperatively demonstrates absence of dural enhancement and expansion of the cerebrum into the space previously occupied by tumorous bone (Fig. 5).

Bottom Line: Design, Setting, and Participant A 37-year-old woman with persistent chronic headaches was found to have an anterior skull base meningioma with extension into the forehead frontal bone.Main Outcome Measures and Results Twenty-nine months postoperatively, the patient had an excellent cosmetic outcome with no radiographic evidence of tumor recurrence or significant bone flap resorption.Conclusion Intraoperative extracorporeal irradiation of tumorous calvaria during meningioma surgery is an effective, logistically feasible treatment option to achieve local tumor control and excellent cosmetic outcome.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States.

ABSTRACT
Objectives Complete removal of infiltrated bone is required to achieve a Simpson Grade 1 meningioma resection. Reconstruction of the resulting bone defect is typically achieved with a nonnative implant that can result in poor cosmesis, foreign body reaction, or infection. Extracorporeal irradiation and reimplantation of tumorous bone has been used for limb-sparing surgery with excellent results, but this treatment option is not routinely considered in meningioma surgery. We present a case of anterior fossa meningioma with tumorous overlying calvarium that was successfully managed with intraoperative extracorporeal irradiation and reimplantation. Design, Setting, and Participant A 37-year-old woman with persistent chronic headaches was found to have an anterior skull base meningioma with extension into the forehead frontal bone. Concurrently with mass resection, the bone flap was irradiated intraoperatively with 120 Gy. After resection of the tumor, the bone flap was replaced in its native position. Main Outcome Measures and Results Twenty-nine months postoperatively, the patient had an excellent cosmetic outcome with no radiographic evidence of tumor recurrence or significant bone flap resorption. Conclusion Intraoperative extracorporeal irradiation of tumorous calvaria during meningioma surgery is an effective, logistically feasible treatment option to achieve local tumor control and excellent cosmetic outcome.

No MeSH data available.


Related in: MedlinePlus