Abo Kasem Rahim, Joseph Karan, Shaik Adnan, Downes Angela, Janjua M Burhan
Department of Neurosurgery Medical University of South Carolina Charleston South Carolina USA.
Department of Neurosurgery Washington University School of Medicine St. Louis Missouri USA.
Clin Case Rep. 2024 Jun 5;12(6):e8967. doi: 10.1002/ccr3.8967. eCollection 2024 Jun.
Palliative surgical resection of extra-calvarial metastatic lesions from renal cell tumors is crucial for controlling metastatic spread, improving quality of life, and preventing associated morbidity. Careful surgical planning, including selective preoperative embolization and controlled resection around critical structures such as the sagittal sinus, is essential for successful outcomes. Cranioplasty with Titanium mesh and bone cement post-resection can provide symptomatic relief, better cosmesis, and overall improved quality of life.
Renal cell carcinomas are aggressive tumors with distant systemic disease. The calvarium appears to be an unusual and rare site for distant metastasis. The treatment modalities are challenging and out of the normal realm for the management of these tumors. We report a case of a 63-year-old woman with a previous history of nephrectomy who presented with symptoms of severe headaches, and swelling of bi-frontal and bi-parietal scalp regions due to multifocal extracalvarial disease. Preoperative bilateral superficial temporal artery embolization was performed to control the intraoperative bleeding. Surgical technique has been described with the critical steps involved, and a literature review has been conducted. Palliative tumor resection surgery was performed to improve the patient's quality of life as well as to confirm the histopathological diagnosis. Gross total resection of the extracalvarial metastatic tumor was achieved. Biopsy confirmed renal cell tumor with the clear cell subtype. The patient recovered well from her surgery with slow healing of the scalp wound. At 6-month follow-up, no recurrence of the extracalvarial disease was observed on serial imaging. Extracalvarial metastasis is a rare presentation in renal cell carcinoma. Considering the inherent radioresistant nature of the tumor, palliative surgical resection can be offered to control the metastatic spread, relieve agonizing pain symptoms, and to improve the quality of life. Preoperative embolization helps to decrease intraoperative blood loss. Moreover, palliative surgical resection of extracalvarial diseases helps to treat the metastasis as well as avoiding the associated morbidity that may occur if left untreated.
对肾细胞肿瘤的颅外转移性病变进行姑息性手术切除对于控制转移扩散、改善生活质量以及预防相关并发症至关重要。精心的手术规划，包括选择性术前栓塞以及在矢状窦等关键结构周围进行控制性切除，对于取得成功的手术结果至关重要。切除术后使用钛网和骨水泥进行颅骨成形术可缓解症状、改善美观并整体提高生活质量。
肾细胞癌是具有远处系统性疾病的侵袭性肿瘤。颅骨似乎是远处转移的一个不寻常且罕见的部位。治疗方式具有挑战性，超出了这些肿瘤常规的管理范畴。我们报告一例63岁女性病例，该患者既往有肾切除术病史，因多灶性颅外疾病出现严重头痛、双侧额部和双侧顶部头皮肿胀症状。术前进行双侧颞浅动脉栓塞以控制术中出血。已描述了手术技术及相关关键步骤，并进行了文献综述。进行了姑息性肿瘤切除手术以改善患者生活质量并确认组织病理学诊断。实现了颅外转移性肿瘤的大体全切。活检证实为肾细胞肿瘤，透明细胞亚型。患者术后恢复良好，头皮伤口愈合缓慢。在6个月的随访中，系列影像学检查未观察到颅外疾病复发。颅外转移在肾细胞癌中是一种罕见表现。考虑到肿瘤固有的放射抵抗特性，可提供姑息性手术切除以控制转移扩散、缓解痛苦的疼痛症状并改善生活质量。术前栓塞有助于减少术中失血。此外，对颅外疾病进行姑息性手术切除有助于治疗转移灶，同时避免如果不治疗可能发生的相关并发症。
