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

Amir Aziz, Khurram Ishaque


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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