Multi-disciplinary Approach: A Modality of Choice in the Management of Osteolytic Skull Lesions

Amir Aziz, Khurram Ishaque

Abstract


Introduction: Multi-disciplinary approach towards the management of osteolytic skull lesions has evolved as the standard modality of treatment in recent years. Multiple disciplines including Neurosurgery, Anaesthesia,Neuro-Radiology, Plastic Surgery and Neuro-Oncology being working in co-ordination have improved outcome in such cases.
Objective: To discuss multi-disciplinary approach as a standard treatment modality of choice.
Study Design: Prospective descriptive study.
Material and Methods: Patients admitted and operated at the Department of Neurosurgery of PGMI/Lahore General Hospita from July 2015 to July 2016. A total of 20 (n = 20) were study subjects.
Results: Among 25 patients that were operated for an osteolytic skull lesion 12 were male and 13 female patients with age ranging from 10 to 60 years. Major complaints swelling (painfull/painless, n = 20), headache (n = 18), vomiting (n = 20), fits (n = 15) and bleeding ulcer (n = 2). On the basis of clinical and MRI diagnosis and biopsy majority had ewing sarcoma (n=10), 5 had meningioma, 1 had chondrosarcoma and 4 had metastatic skull lesion. All of them (n = 20) underwent surgery related to their clinical and MRI findings which included biopsy, excision of lesion, cranioplasty and flap rotation. Complications included infection in 2 patients, which was treated with antibiotics and mortality in 1 case.
Outcome: Neurologic status and outcomes were compared with preoperative findings at 1st and 2nd post-operative weeks. Headache, fits, vomiting significantly improved in all patients.
Follow-up: All patients had a follow up at 1 and 3 months post-operative.
Conclusions: A multi-disciplinary approach is the modality of choice in managing an osteolytic skull lesions.By involving different specialities in a team effort to manage an osteolytic skull lesion can greatly improve the outcome in such cases.
Key Words: Osteolytic skull lesion, cranioplasty, flap rotation.

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References


Artico M, De Caro GM, Salvati M, Carloia S, Rastelli E, Wierzbicki V, Manni M: Solitary metastases to the cranial vault. Report of ten cases. J Neurosurg Sci. 2000; 44 (1): 33-38.

Hong B, Hermann EJ, Klein R, Krauss JK, Nakamura M: Surgical resection of osteolytic calvarial lesions: Clinicopathological features. Clin Neurol Neurosurg. 2010; 112 (10): 865-869.

Mitsuya K, Nakasu Y, Horiguchi S, Harada H, Nishi-mura T, Yuen S, Asakura K, Endo M: Metastatic skull tumors: MRI features and a new conventional classifi-cation. J Neurooncol. 2011; 104 (1): 239-245.

Moon WJ, Lee MH, Chung EC: Diffusion-weighted imaging with sensitivity encoding (SENSE) for detect-ing cranial bone marrow metastases: Comparison with T1-weighted images. Korean J Radiol. 2007; 8 (3): 185-191.

Neubauer KE, Goldstein GD, Plumb SJ. Squamous cell carcinoma of the scalp in organ transplant recipients: Exploring mechanisms for recurrence and treatment guidelines. Dermatol Surg. 2010; 36: 185–93.


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