Intra-operative extracorporeal irradiation of tumour-invaded craniotomy bone flap in meningioma: a case series.
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BACKGROUND: Extracorporeal irradiation of tumorous calvaria (EITC) can be performed to restore function and form of the skull after resection of bone-invasive meningioma. We sought to examine the rate of tumour recurrence and other selected outcomes in patients undergoing meningioma resection and EITC. METHODS: Retrospective single-centre study of adult patients undergoing meningioma resection and EITC between January 2015 and November 2022 at a tertiary neurosurgical centre. Patient demographics, surgery data, tumour data, use of adjuvant therapy, surgical complications, and tumour recurrences were collected. RESULTS: Eighteen patients with 11 (61%) CNS WHO grade 1, 6 (33%) grade 2, and 1 (6%) grade 3 meningiomas were included. Median follow-up was 42 months (range 3-88). Five (28%) patients had a recurrence, but none were associated with the bone flap. Two (11%) wound infections requiring explant surgery occurred. Six (33%) patients required a further operation. Two operations were for recurrences, one was for infection, one was a washout and wound exploration but no evidence of infection was found, one patient requested the removal of a small titanium implant, and one patient required a ventriculoperitoneal shunt for a persistent CSF collection. There were no cases of bone flap resorption and cosmetic outcome was not routinely recorded. CONCLUSION: EITC is feasible and fast to perform with good outcomes and cost-effectiveness compared to other reconstructive methods. We observed similar recurrence rates and lower infection rates requiring explant compared to the largest series of cranioplasty in meningioma. Cosmetic outcome is universally under-reported and should be reported in future studies.
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Acknowledgements: The Authors would like to thank Mrs Sue Tabor, Superintendent Radiographer, for supporting the delivery of extracorporeal radiotherapy for the patients described in this manuscript. This study did not receive any funding or financial support. William H. Cook is supported by a Woolf Fisher Scholarship from the Woolf Fisher Trust of New Zealand and Cambridge Commonwealth, European & International Trust, and by Christ’s College, University of Cambridge. Adel E. Helmy is supported by the NIHR Biomedical Research Centre, the NIHR Brain Injury MedTech Co-operative, and the Royal College of Surgeons of England.
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0942-0940