School of Medicine, Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
School of Medicine, Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
Neurosurg Rev. 2021 Jun;44(3):1583-1589. doi: 10.1007/s10143-020-01347-7. Epub 2020 Jul 10.
Combined scalp and skull deficiency due to malignant scalp tumors or sequelae of intracranial surgery present challenging entities for both neurosurgeons and reconstructive treatment. In complex cases, an interdisciplinary approach is needed between neurosurgeons and cranio-maxillofacial surgeons. We present a considerably large series for which we identify typical complications and pitfalls and provide evidence for the importance of an interdisciplinary algorithm for chronic wound healing complications and malignomas of the scalp and skull. We retrospectively reviewed all patients treated by the department of neurosurgery and cranio-maxillofacial surgery at our hospital for complex scalp deficiencies and malignant scalp tumors affecting the skull between 2006 and 2019, and extracted data on demographics, surgical technique, and perioperative complications. Thirty-seven patients were treated. Most cases were operated simultaneously (n: 32) and 6 cases in a staged procedure. Nineteen patients obtained a free flap for scalp reconstruction, 15 were treated with local axial flaps, and 3 patients underwent full thickness skin graft treatment. Complications occurred in 62% of cases, mostly related to cerebrospinal fluid (CSF) circulation disorders. New cerebrospinal fluid (CSF) disturbances occurred in 8 patients undergoing free flaps and shunt dysfunction occurred in 5 patients undergoing local axial flaps. Four patients died shortly after the surgical procedure (perioperative mortality 10.8%). Combined scalp and skull deficiency present a challenging task. An interdisciplinary treatment helps to prevent severe and specialty-specific complications, such as hydrocephalus. We therefore recommend a close neurological observation after reconstructive treatment with focus on symptoms of CSF disturbances.
头皮和颅骨联合缺损是由恶性头皮肿瘤或颅内手术的后遗症引起的，对神经外科医生和重建治疗医生来说都是极具挑战性的。在复杂的情况下，需要神经外科医生和颅面外科医生之间进行跨学科的方法。我们提出了一个相当大的系列，我们确定了典型的并发症和陷阱，并为慢性伤口愈合并发症和头皮和颅骨恶性肿瘤的跨学科算法的重要性提供了证据。我们回顾性地审查了 2006 年至 2019 年期间，我院神经外科和颅面外科治疗的所有复杂头皮缺损和颅骨受累的恶性头皮肿瘤的患者，并提取了人口统计学、手术技术和围手术期并发症的数据。共治疗了 37 例患者。大多数病例是同时手术（n：32），6 例是分期手术。19 例患者获得头皮重建游离皮瓣，15 例患者采用局部轴形皮瓣治疗，3 例患者行全厚皮片移植治疗。62%的病例发生并发症，主要与脑脊液（CSF）循环障碍有关。游离皮瓣术后 8 例发生新的 CSF 障碍，局部轴形皮瓣术后 5 例发生分流功能障碍。4 例患者在手术后不久死亡（围手术期死亡率 10.8%）。头皮和颅骨联合缺损是一项具有挑战性的任务。跨学科治疗有助于预防严重的和专科特定的并发症，如脑积水。因此，我们建议在重建治疗后进行密切的神经学观察，重点关注 CSF 障碍的症状。
