Tavanaiepour Daryoush, Broaddus William C, Chung Theodore D, Holloway Kathryn L, Proper Michelle A, Wolber Sharon B, Neiderer Keith
Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida;
J Neurosurg. 2015 May;122(5):1127-30. doi: 10.3171/2014.9.JNS131383. Epub 2014 Nov 21.
OBJECT When intracranial tumors invade the overlying skull, gross resection typically includes removal of the involved bone. Methods used to repair the resulting structural defect in the cranium include artificial prostheses, allogeneic bone grafts, and autoclaving the autologous graft. The authors have previously reported a case involving high-dose extracorporeal ionizing radiation to treat the tumorous calvaria intraoperatively, followed by reimplantation of the treated bone flap. In this paper the authors report the long-term follow-up of that case, as well as results of using extracorporeal irradiation of tumorous calvaria (EITC) for an additional 20 patients treated similarly. METHODS The decision to undergo EITC was typically anticipated preoperatively, but determined intraoperatively, if upon inspection the bone flap was invaded by tumor. The bone flap was then delivered to the radiation oncology department, where a total dose of 120 Gy was delivered, using a clinical linear accelerator, over a period of approximately 15 minutes. After the intracranial tumor resection was completed, the irradiated craniotomy bone flap was reimplanted and the wound was closed in a standard fashion. A retrospective review of patients who had undergone EITC was performed for evidence of calvarial tumor recurrence or other complications. RESULTS Since the originally reported case, 20 additional patients have received EITC during craniotomy for invasive tumors. Eighteen (86%) of 21 patients were diagnosed with meningioma: 12 (67%) with WHO Grade I, 5 (28%) with WHO Grade II, and 1 with WHO Grade III (6%). The remaining 3 patients presented with dural-based B-cell lymphoma with extensive adjacent bone invasion (n = 2) and metastatic adenocarcinoma of the lung (n = 1). Follow-up of the 21 patients ranged from 1 to 132 months, with a mean of 41 months and a median of 23 months. No patients have experienced tumor recurrence, infection associated with the treated calvaria, or evidence of bone flap resorption. CONCLUSIONS Calvaria reconstructions represent an important component in structural and cosmetic outcome following craniectomy for tumorous bone. The authors' long-term experience with EITC has been excellent with no local tumor recurrence or complications. Therefore, EITC represents an excellent and efficient option for cranial reconstruction in such patients.
目的 当颅内肿瘤侵犯上方颅骨时，大体切除通常包括切除受累骨质。用于修复颅骨结构缺损的方法包括人工假体、同种异体骨移植和自体骨移植的自体骨高压灭菌。作者此前曾报道过1例术中采用大剂量体外电离辐射治疗颅骨肿瘤，随后将处理后的骨瓣重新植入的病例。在本文中，作者报告了该病例的长期随访情况，以及对另外20例接受类似治疗的患者采用颅骨肿瘤体外照射（EITC）的结果。方法 是否进行EITC通常在术前预判，但如果术中检查发现骨瓣被肿瘤侵犯，则在术中决定。然后将骨瓣送至放射肿瘤科，使用临床直线加速器在约15分钟内给予120 Gy的总剂量。颅内肿瘤切除完成后，将经照射的开颅骨瓣重新植入，并按标准方式关闭伤口。对接受EITC的患者进行回顾性分析，以寻找颅骨肿瘤复发或其他并发症的证据。结果 自最初报道该病例以来，又有20例患者在开颅手术治疗侵袭性肿瘤时接受了EITC。21例患者中有18例（86%）被诊断为脑膜瘤：12例（67%）为世界卫生组织（WHO）I级，5例（28%）为WHO II级，1例（6%）为WHO III级。其余3例患者分别为伴有广泛相邻骨质侵犯的硬脑膜B细胞淋巴瘤（2例）和肺转移性腺癌（1例）。21例患者的随访时间为1至132个月，平均41个月，中位数23个月。没有患者出现肿瘤复发、与处理后的颅骨相关的感染或骨瓣吸收的证据。结论 颅骨重建是肿瘤性骨开颅术后结构和美容效果的重要组成部分。作者对EITC的长期经验良好，无局部肿瘤复发或并发症。因此，EITC是此类患者颅骨重建的一种极佳且有效的选择。
