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Giant metastasis to the parietooccipital skull with intracranial invasion: surgical management and evolution after embolization
EANS Academy. Rico Pereira M. 09/25/19; 275327; EP03075
Marta Rico Pereira
Marta Rico Pereira

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Abstract
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Methods: A 49-year-old female patient with a history of colon cancer with pulmonary dissemination in the course of chemotherapy started development and rapidly progressive growth of parieto occipital skull lesion. CT and MRI were performed, showing a large extracranial and intracranial lesion with osteolysis in the left parieto occipital bone, with heterogeneous appearance and approximate sizes of 97 mm x 63 mm x 110 mm, volume greater than 2,500 cm3.
Results: The patient underwent surgical intervention, prior preoperative embolization, with reduced intraoperative bleeding. An occipital midline incision was performed with dissection of the extracranial component of the lesion, showing significant involvement of tissues, mainly osseous, including dura mater. The cystic content was evacuated and skin reconstruction was carried out. The anatomopathological result showed moderately differentiated adenocarcinoma with marked mucosecretion. In the immediate postoperative period, the patient remained clinically stable and she was discharged after a few days. Later she suffered from scalp complications related to preoperative embolization, with cutaneous suffering, necrosis and dehiscence, requiring reoperation by cutaneous flap.
Conclusion: Giant metastasis in relation to the skull are able to behave aggressively with rapidly progressive growth. Its management requires a multidisciplinary approach, surgical resection being a fundamental pillar. Previous embolization of skull lesions helps significantly reduce intraoperative bleeding. However, it can lead to important problems regarding the scalp that can significantly compromise the postoperative period.
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