Double concentric craniotomy: Safe and effective technique to achieve an en bloc resection of tumor involving both skull and duraa

R Fornaro; R Altieri; D Garbossa; F Zenga; F Tartara; A Ducati

doi:10.1016/j.ijscr.2015.05.017

Double concentric craniotomy: Safe and effective technique to achieve an en bloc resection of tumor involving both skull and duraa

Int J Surg Case Rep. 2015:12:117-9. doi: 10.1016/j.ijscr.2015.05.017. Epub 2015 May 14.

Authors

R Fornaro¹, R Altieri², D Garbossa¹, F Zenga¹, F Tartara¹, A Ducati¹

Affiliations

¹ University of Torino, Dept. Of Neuroscience, Institute of Neurosurgery, Italy.
² University of Torino, Dept. Of Neuroscience, Institute of Neurosurgery, Italy. Electronic address: roberto.altieri.87@gmail.com.

Abstract

Introduction: Many tumors can involve the skull. Meningiomas are one of the most common intracranial neoplasms and invasion of the bone was described in 49% of cases. Other neoplastic lesions that can arise in bone, or involve it, are metastases, hemangiomas, aggressive cutis carcinomas and sarcomas. Radical excision is the golden standard of treatment but elevating a bone flap when the tumor involves both the skull and the dura could represent a technical challenge.

Presentation of case: We report the technical details of our approach to remove a meningioma involving both skull and dura in a man aged 45. Patient underwent gross total excision and cranioplasty with PEEK custom made prothesis (Synthes™).

Discussion: We describe a double concentric craniotomy (DCC) technique where the tumor involving the bone is before left in situ, exposing normal dura, to perform afterwards en-bloc excision with minimal traction of brain surface.

Conclusion: DCC is a safe and effective technique to remove tumor involving both skull and dural structures under direct vision.

Keywords: Brain tumor; Concentric craniotomy; En bloc resection; Skull tumor.