Huntoon Kristin M, Mayer Rory R, Fahim Daniel K, Kumar Saloni, Adelman David M, McCutcheon Ian E
Departments of1Neurosurgery and.
2Ascension Texas Spine and Scoliosis, Austin, Texas.
J Neurosurg. 2023 Sep 29;140(4):979-986. doi: 10.3171/2023.7.JNS23974. Print 2024 Apr 1.
Malignant cancers arising in the scalp may exhibit calvarial invasion, dural extension, and rarely cerebral involvement. Typically, such lesions require a multidisciplinary approach involving both neurosurgery and plastic surgery for optimal resection and reconstruction. The authors present a retrospective analysis of patients with scalp malignancies who underwent resection and reconstruction.
Patients presenting with scalp malignancies (1993-2021, n = 84) who required neurosurgical assistance for tumor resection were prospectively entered into a database. These data were retrospectively reviewed for this case series. The extent of neurosurgical resection was classified into four levels of involvement: scalp (level I), calvarial (level II), dural (level III), or intraparenchymal (level IV). Complications and evidence of local, locoregional, or regional recurrence were documented.
Patients underwent level I (n = 2), level II (n = 61), level III (n = 13), and level IV (n = 8) resections. Pathologies consisted of primarily squamous cell carcinoma (n = 50, 59.5%), basal cell carcinoma (n = 11, 13.1%), and melanoma (n = 9, 10.7%), with infrequent lesions including sarcoma, atypical fibroxanthoma, and malignant fibrous histiocytoma. For cases requiring a cranioplasty, 92.2% were done using titanium mesh and 7.8% with methylmethacrylate. At a mean follow-up of 35.5 ± 45.9 months, the overall survival was 48.8% (n = 41) and recurrence-free survival was 31.0% (n = 43). Scalp-based reconstruction involving plastic surgery was performed in 75 (89.3%) patients. The most commonly used free flap was a latissimus dorsi muscle flap (n = 46, 61.3%). One or more postoperative complications occurred in 21.4% of all patients, the most common being wound dehiscence or delayed wound healing in 13% (n = 11).
A multidisciplinary approach with aggressive neurosurgical resection is associated with good outcomes in patients with primary malignant scalp tumors, despite invasive disease on presentation. This analysis suggests that aggressive resection (level II and higher) is effective at reducing locoregional recurrence and is not associated with a higher risk of complications relative to resection without craniectomy. As most patients require scalp reconstruction to close the postresection defect, usually with vascularized free tissue transfer, involving a plastic surgeon in the surgical planning and execution is essential.
头皮发生的恶性肿瘤可能会侵犯颅骨、累及硬脑膜，很少会累及脑实质。通常，此类病变需要神经外科和整形外科的多学科方法来实现最佳的切除和重建。作者对接受切除和重建的头皮恶性肿瘤患者进行了回顾性分析。
前瞻性地将1993年至2021年期间因头皮恶性肿瘤需要神经外科辅助进行肿瘤切除的患者（n = 84）纳入数据库。对该病例系列进行回顾性数据审查。神经外科切除范围分为四个累及级别：头皮（I级）、颅骨（II级）、硬脑膜（III级）或脑实质内（IV级）。记录并发症以及局部、区域或远处复发的证据。
患者接受了I级（n = 2）、II级（n = 61）、III级（n = 13）和IV级（n = 8）切除。病理类型主要包括鳞状细胞癌（n = 50，59.5%）、基底细胞癌（n = 11，13.1%）和黑色素瘤（n = 9，10.7%），少见病变包括肉瘤、非典型纤维黄色瘤和恶性纤维组织细胞瘤。对于需要颅骨成形术的病例，92.2%使用钛网，7.8%使用甲基丙烯酸甲酯。平均随访35.5±45.9个月，总生存率为48.8%（n = 41），无复发生存率为31.0%（n = 43）。75例（89.3%）患者进行了涉及整形外科的头皮重建。最常用的游离皮瓣是背阔肌皮瓣（n = 46，61.3%）。21.4%的所有患者发生了一种或多种术后并发症，最常见的是伤口裂开或伤口愈合延迟，占13%（n = 11）。
尽管初诊时病情具有侵袭性，但对于原发性头皮恶性肿瘤患者，采用积极的神经外科切除的多学科方法可带来良好的治疗效果。该分析表明，积极切除（II级及以上）可有效降低局部区域复发风险，且与不进行颅骨切除术的切除相比，并发症风险不会更高。由于大多数患者需要进行头皮重建以闭合切除后的缺损，通常采用带血管的游离组织转移，因此在手术规划和实施过程中让整形外科医生参与至关重要。
