PMC8490705_01
(A) Clinical image of the 8-cm scalp tumor. (B) Sagittal and (C) coronal gadolinium-enhanced T1- weighted magnetic resonance imaging depicting a biconvex mass with extracranial and intracranial invasion, compressing bilateral brain tissue. (D) A sagittal computed tomography (CT) image showing an osteoblastic lesion. (E) Angiographic tumor staining of the left middle meningeal artery. At the 6-month follow-up (E), sagittal and coronal CT (F,G) and 3D reconstruction image (H,I) illustrated normal skull contour with a solid fusion of the graft to the skull.
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F1
He presented with a rapidly enlarging scalp mass for 5 months (Figure 1A). Gadolinium-enhanced magnetic resonance imaging showed a heterogeneously enhanced biconvex mass (Figures 1B-D). Angiography revealed that the main tumor feeding artery came from the left and right middle meningeal arteries (Figure 1E). During the 6-month follow-up, imagines showed no in-situ tumor recurrence and partial bone healing (Figures 1F-I).
Intraoperative images (A) Following reflecting the galea showing a well-demarcated extracranial tumor. (B) After removal of the extracranial tumor showing the osteoblastic tumor-bearing bone. (C) The intracranial tumor was removed with the preservation of the superior sagittal sinus (*). (D) Duraplasty with tensor fascia lata. (E)
Ex vivo cryotherapy was done with the autologous bone graft by soaking it in liquid nitrogen for 20 min (F), thawing it in room air for 10 min and soaking it in povidone-iodine solution for 15 min. The nitrogen-treated graft (G) was fixed back in situ with plates and screws (H).
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F2
Intraoperatively, an encapsulated tumor was dissected from the subgaleal layer after a U-shaped incision (Figure 2A). En bloc resection of the osteoblastic bone was performed using the craniotome under navigation guidance (Figure 2B). The intracranial tumor was removed per segment, and the involved dura was excised while preserving the superior sagittal sinus (Figure 2C). After completely removing the tumor, duraplasty was performed using a tensor fascia lata graft (Figure 2D). Meanwhile, the resected osteoblastic bone graft was scheduled for ex vivo cryotherapy (Figures 2E-G). After cryotherapy, the bone graft was fixed to the skull defect with plates and screws (Figure 2H).
Summary of the ex vivo cryotherapy.
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F3
The cryotherapy was summarized in Figure 3 with an illustrative video (Supplementary File).