cranial sarcoma resection

Skull sarcoma is rare and occurs mostly in young people. May include cranial periosteal sarcoma, chondrosarcoma, osteofibrosarcoma, Ewing sarcoma and osteomyeloma. The tumor grows rapidly, the blood supply is abundant, and it can be transferred to the distant part at an early stage, and the prognosis is poor. Tumors often grow in both the intracranial and extracranial directions. Some of the tumors may also be secondary to the late stage of bone fiber dysplasia. The disease begins to grow in a certain part of the skull, showing mild pain. With the development of the tumor, the headache can be aggravated, and the head deforms, which is characterized by scalp tension, brightening, flushing, varicose veins, and even local audible and vascular murmur. If the tumor is destroyed to the inner plate of the skull, it can be compressed into the brain and involve the dura mater and brain tissue, causing intracranial hypertension. Epilepsy, hemiplegia, aphasia, etc. can occur. If the tumor is located at the base of the skull, the corresponding symptoms of cranial nerve involvement may occur. In addition, systemic symptoms of malignant tumors such as fatigue, weakness and anemia, and elevated body temperature can also occur. There are characteristic changes in X-ray, cerebral angiography or CT examination, and the skull biopsy can confirm the diagnosis. Generally advocate surgical resection, plus chemotherapy and radiotherapy. Treatment of diseases: osteofibrosarcoma chondrosarcoma Indication 1. If the tumor is small and there is no systemic metastasis, the lesion is not at the base of the skull and is not located at the large blood vessel. 2. Although the tumor is large, but located in the calvarial part, the physical condition is better, can tolerate the surgery, and can also be surgically removed. Contraindications 1. The tumor has been transferred. 2. Patient failure cannot tolerate the operator. Preoperative preparation Before the operation, the blood supply of the tumor should be clarified, and the relationship between the tumor and the intracranial structure should be known. If the blood supply is rich, the external carotid artery of the lesion can be embolized or ligated before surgery to reduce bleeding. Surgical procedure Incision Generally, a large valve-shaped incision is used, which directly reaches the aponeurosis of the cap and peels off the flap. Since the blood supply of the tumor is rich and the bleeding is more, the blood should be carefully stopped. 2. Tumor exposure The tumor has adhesion to the muscle periosteum, etc., so after the separation of the flap, more than the adhesion of the periosteum, muscle separation, and in the normal skull periosteum around the tumor, incision and peeling, bleeding will immediately stop bleeding with bone wax. 3. Osteoma resection The normal skull around the tumor is revealed, and 4 to 6 holes are drilled in the normal skull 2 cm away from the osteoma. If the tumor and the dura mater are non-adhesive, the bone flap can be sawed, or the skull between the bone holes can be bitten by a rongeur, and the tumor can be removed together with the bone flap. If the tumor adheres to the dura mater, the meninges are cut open at the normal dura mater, and the tumor-side dura mater is passed through the silk thread for pulling. Gently lifting reveals the boundaries between brain tissue and the tumor, and many new blood vessels grow. One by one electrocoagulation to stop bleeding, careful separation, and complete removal of the tumor. If the tumor has grown into the brain, the bone flap and the dura mater are also treated by the above method, such as bleeding, and the boundary between the tumor and the brain tissue is unclear, and the tumor close to the dura mater can be burned and cut by unipolar electrocoagulation. First, the tumor invading the dura mater and the skull and soft tissue is removed, and the tumor in the residual brain is removed again. If the condition is completely removed, the CUSA can be removed under the operating microscope, and the effect will be better. After tumor resection, if the intracranial pressure is not high, the dura mater can be repaired with fascia or artificial meninges. 4. Incision suture Because of the high degree of malignancy, many do not advocate skull repair. After complete hemostasis, a rubber tube was placed under the dura mater or the epidural, and the aponeurosis and skin were tightly sutured. The drainage tube was removed after 48 hours. complication 1. Postoperative intracranial hematoma formation, can cause symptoms of consciousness, hemiplegia and other symptoms. 2. Incision infection or intracranial infection. 3. Transfer of distant parts. 4. Tumor recurrence in the short term.