Does Putting Back Hyperostotic Bone Flap in Meningioma Surgery Cause Tumor Recurrence? An Observational Prospective Study

Replacing the skull defect with synthetic materials for hyperostotic bone secondary to meningioma is recommended owing to the possibility of tumor invasion. In our institution, neurosurgeons have been putting back the refashioned hyperostotic bone flap after meningioma excision because of budget con...

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Bibliographic Details
Published in:	World neurosurgery Vol. 127; pp. e497 - e502
Main Authors:	Lau, Bik Liang, Che Othman, Mohd Iryan, Fathil, Mohd Fakhri M.D., Liew, Donald Ngian San, Lim, Swee San, Bujang, Mohamad Adam, Wong, Albert Sii Hieng
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-07-2019
Subjects:	Adult Aged Cranioplasty Craniotomy - adverse effects Female Humans Hyperostosis Hyperostosis - complications Male Meningeal Neoplasms - surgery Meningioma Meningioma - surgery Middle Aged Neoplasm Recurrence, Local - surgery Prospective Studies Recurrence Simpson Skull - surgery Surgical Flaps - surgery Recurrence CT Cranioplasty Hyperostosis Meningioma Simpson WHO
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Summary:	Replacing the skull defect with synthetic materials for hyperostotic bone secondary to meningioma is recommended owing to the possibility of tumor invasion. In our institution, neurosurgeons have been putting back the refashioned hyperostotic bone flap after meningioma excision because of budget constraints. The aim of this study was to review the long-term meningioma recurrence rate in these patients. This was a nonrandomized, prospective observational study conducted from September 2011 to January 2015 on patients with intracranial convexity and parasagittal meningiomas. Preoperative computed tomography brain scans were obtained in all patients to confirm bony hyperostosis. Intraoperatively, part of the hyperostotic bone was sent for histopathologic examination. The rest of the bone flap was refashioned by drilling off the hyperostotic part. The bone flap was put back over the craniotomy site after soaking in distilled water. All patients were followed up for tumor recurrence. The study included 34 patients with convexity or parasagittal meningioma World Health Organization grade I–II who underwent Simpson grade Ia and IIa excision. Median follow-up was 63.5 months (mean 64.9 ± 9.4 months). The hyperostotic bone flap showed presence of tumor in 35% of patients. There were 2 patients with parasagittal meningiomas after Simpson grade IIa resections who developed tumor recurrences. Our study found that meningioma recurrence was unlikely when autologous cranioplasty was done with refashioned hyperostotic bone. This could be done in the same setting with meningioma excision. There was no recurrence in convexity meningiomas at mean 5-year follow-up.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1878-8750 1878-8769
DOI:	10.1016/j.wneu.2019.03.183