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

  • Khuram Ishaq Departments of Neurosurgery
  • AMIR AZIZ Departments of Neurosurgery, Post Graduate Medical Institute
  • KHAWAJA SHAHID SAJJAD DAR Departments of Neurosurgery, Post Graduate Medical Institute
  • Syed Shahrukh Rizvi Departments of Neurosurgery, Post Graduate Medical Institute
  • Abdullah . Departments of Neurosurgery, Post Graduate Medical Institute
Keywords: Osteolytic skull lesion,, cranioplasty, flap rotation

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.

References

1. 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. 2. 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.
3. 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. 4. 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. 5. 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.
Published
2018-10-04
Section
Original Articles