Objective: To investigate the operative procedure and the effectiveness of cranial bone reconstruction after one-stage resection of scalp squamous carcinoma invading the skull.
Methods: Between January 2005 and December 2008, 14 patients with scalp squamous carcinoma invading the skull were treated. There were 6 males and 8 females with a median age of 53 years (range, 29-76 years). The disease duration ranged from 3 to 8 years (mean, 6 years). The tumor locations were right temporal area in 2 cases, left temporal area in 2 cases, right frontal area in 3 cases, left frontal area in 1 case, right occipital area in 1 case, left occipital area in 2 cases, frontal area in 2 cases, and the top of the head in 1 case. Scalp lesions showed exogenous growth, and lesion diameter ranged from 5 to 12 cm (mean, 8 cm). TNM classification showed T4N0M0 tumor in all cases. MRI showed that tumors invaded the skull, 12 cases had smooth intradural side and 2 cases had brain involvement without lymph node metastasis or detected distant metastasis. Under general anesthesia, all the lesions of the scalp, skull, dura, and brain tissue were removed completely. The size defect of the scalp, skull, and dura ranged from 8 cm x 7 cm to 15 cm x 14 cm, from 5 cm x 4 cm to 12 cm x 12 cm, and from 4 cm x 4 cm to 9 cm x 8 cm, respectively, which were repaired with artificial patch, titanium metal, mesh, and local flaps, respectively. The donor site was repaired by split-thickness skin graft.
Results: The skin flaps and grafts survived and incision healed by first intention without cerebrospinal fluid leakage, intracranial and subdural hemorrhage, and other complications. All patients were followed up 2 to 5 years (mean, 4 years), and no recurrence was found. The compatibility of titanium mesh and local tissue was good. The patients had good hair growth without exposure of titanium mesh, seizures, partial paralysis, and other neurological damage performance.
Conclusion: After one-stage resection of scalp squamous carcinoma invading the skull, it is effective to reconstruct the skull with titanium mesh and to repair dural defects with artificial dura.