Multidiscipilinary Apprach to Metastatic Skull Lesions; Endovascular Embolization, Gross Total Excision and Carnioplasty

Abstract
Background: Metastatic skull lesions are being more frequently diagnosed. There are many reports of skull metas-tases from approximately all cancer types. Clinical presentation of these lesions includes cosmetic complaints and neurological deficits attributable to site of the lesion. Management modal-ities of metastatic skull lesions include radiation therapy, chemotherapy, pre-operative endovascular embolization and surgical excision.
Aim of Study: The aim of this work is to evaluate the outcome of metastatic skull tumor embolization, gross total resection and cranioplasty.
Patient and Methods: This study included 8 patients with metastatic calvarial skull lesions admitted to Department of Neurosurgery, Tanta University between January 2015 and March 2018. All patients were subject to 2 stages of manage-ment; endovascular embolization, surgical excision and crani-oplasty.
Results: This study included 8 patients (4 male and 4 female) with main age 53 years. Pathologic types included; 3 patients with renal cell carcinoma, 2 with cancer breast, 2 with hepatocellular carcinoma and 1 with thyroid adenocar-cinoma. All patients were presented for cosmetic reason except one patient who had right hemiparesis. In all patients, near total pre-operative embolization was done without technique-related morbidity or mortality. Gross total excision was possible in all patients. Excision was followed by cranioplasty using a titanium mesh. Operative complications included aseptic necrosis of the edge of the wound in one patient and healed in 1 month by daily dressing. One patient died because of unrelated cause 2 days post-operatively.
Conclusion: Multidisciplinary approach to metastatic skull lesions by adding pre-operative embolization to excision and cranioplasty to such lesions provides better chances of gross total excision with minimal morbidities.