Giant malignant meningioma invading the calvarial bone and scalp.

Meningiomas are common and mostly benign intracranial tumors, but malignant meningioma is a rare subtype with high recurrence rate and poor prognosis. Also, most meningiomas grow intracranially, and extracranial growth of meningiomas has rarely been reported. We present here a rare case of a giant malignant meningioma with multiple recurrences. The patient was a 73-year-old woman who was evaluated to have a malignant meningioma of the frontal part of the skull 3 years before being admitted to our hospital and received surgical treatment. The tumor recurred 3 years after the first surgery and was classified as a giant meningioma on admission to our hospital. We performed total resection of the giant meningioma and reconstructed the defect with artificial dura, skull, and a local rotating flap. The patient recovered and lived well for 1 year. However, 15 months after surgery, the patient died of the recurrent tumor after refusing any treatment. Meningiomas are usually common and benign intracranial tumors; however, the anaplastic subtype of meningiomas is rare and malignant. Despite the high rates of recurrence and metastasis, surgery is still an option. For giant invasive tumors, the cooperation of neurosurgeons and plastic surgeons is essential.

[Cranial bone reconstruction after one-stage resection of scalp squamous carcinoma invading the skull].

OBJECTIVE: To investigate the operative procedure and the effectiveness of cranial bone reconstruction after one-stage resection of scalp squamous carcinoma invading the skull. METHODS: Between January 2005 and December 2008, 14 patients with scalp squamous carcinoma invading the skull were treated. There were 6 males and 8 females with a median age of 53 years (range, 29-76 years). The disease duration ranged from 3 to 8 years (mean, 6 years). The tumor locations were right temporal area in 2 cases, left temporal area in 2 cases, right frontal area in 3 cases, left frontal area in 1 case, right occipital area in 1 case, left occipital area in 2 cases, frontal area in 2 cases, and the top of the head in 1 case. Scalp lesions showed exogenous growth, and lesion diameter ranged from 5 to 12 cm (mean, 8 cm). TNM classification showed T4N0M0 tumor in all cases. MRI showed that tumors invaded the skull, 12 cases had smooth intradural side and 2 cases had brain involvement without lymph node metastasis or detected distant metastasis. Under general anesthesia, all the lesions of the scalp, skull, dura, and brain tissue were removed completely. The size defect of the scalp, skull, and dura ranged from 8 cm x 7 cm to 15 cm x 14 cm, from 5 cm x 4 cm to 12 cm x 12 cm, and from 4 cm x 4 cm to 9 cm x 8 cm, respectively, which were repaired with artificial patch, titanium metal, mesh, and local flaps, respectively. The donor site was repaired by split-thickness skin graft. RESULTS: The skin flaps and grafts survived and incision healed by first intention without cerebrospinal fluid leakage, intracranial and subdural hemorrhage, and other complications. All patients were followed up 2 to 5 years (mean, 4 years), and no recurrence was found. The compatibility of titanium mesh and local tissue was good. The patients had good hair growth without exposure of titanium mesh, seizures, partial paralysis, and other neurological damage performance. CONCLUSION: After one-stage resection of scalp squamous carcinoma invading the skull, it is effective to reconstruct the skull with titanium mesh and to repair dural defects with artificial dura.

[Premovement of polyacrylamide hydrogel (PAAH) from breast through submammary fold incision].

OBJECTIVE: To investigate the bad effect of breast augmentation with PAAH injection and the technique to remove PAAH from breast effectively and safely. METHODS: 43 cases (86 sides) underwent operation to remove the PAAH from breast through submammary incision, followed by dressing with pressure for 3 days. The patients received colored doppler ultrasonography and immunologic test before and 3 months after operation. RESULTS: Postoperative ultrasonography showed residual PAAH in breast in one case. Among the 20 cases who had preoperative breast pain, the pain relieved completely in 10 cases and improved in the other 10 cases. All the patients had some abnormal results in immunologic test which improved 3 months after operation. CONCLUSIONS: Breast augmentation with PAAH injection can result in breast pain and other complications. It may also have bad effect on the immune system. PAAH should be removed as soon as possible. The technique through submammary incision to remove PAAH is one of the safe and reliable methods.