Múltiplos tumores de escalpe com invasão intracraniana: Exérese e reconstrução com retalho miocutâneo de músculo grande dorsal

Resumo

Objetivo O objetivo deste trabalho é descrever o tratamento realizado em um paciente com lesão de escalpe, com invasão e destruição craniana, invasão da dura-máter e comprometimento cerebral.

Método Relata-se um caso de um paciente masculino, 54 anos, com lesões em couro cabeludo frontal, ulcerada e infectada que destruía a calota craniana, invadia a dura-máter, obstruía o terço anterior do seio sagital superior e apresentava massa que comprimia os lobos frontais. Além disso, apresentava lesões em ambas as orelhas. O paciente foi submetido à ressecção ampla e agressiva, cujo exame anatomopatológico evidenciou carcinoma espinocelular invasor na região frontal e orelha direita, e carcinoma basocelular na região auricular esquerda. Após a ressecção cirúrgica, foi realizada a reconstrução imeditata com enxerto de fáscia lata, costelas e retalho microcirúrgico de músculo grande dorsal.

Resultados Paciente apresentou melhora clínica e estética.

Conclusão Carcinoma de escalpe com acometimento intracraniano é uma condição extremamente grave. O tratamento é multidisciplinar, devendo sempre buscar uma ressecção completa com reconstrução do defeito da forma mais fisiológica e estética possível.

Abstract

Objective The aim of this study is to describe the treatment performed on a patient with a multiple scalp tumors with intracranial invasion and cerebral involvement.

Methods We report a case of a male patient, aged 54, with lesions in the frontal scalp, ulcerated and infected which destroyed the skullcap, it invaded the dura and obstructed the anterior third of the superior sagittal sinus, and he had a tumor compressing the frontal lobes. Moreover, he had lesions in both ears. The patient underwent wide and aggressive resection, whose pathological revealed squamous cell carcinoma invading the frontal region and right ear and basal cell carcinoma in the left auricular region. After surgical resection he was performed immediate reconstruction with fascia lata graft, ribs and microsurgical flap of the latissimus dorsi muscle.

Results The patient had clinical and aesthetics improvement.

Conclusion Carcinoma of scalp with intracranial involvement is an extremely serious condition. The treatment is multidisciplinary and it must always aim at a complete resection with reconstruction of the defect in the most physiological and aesthetic as possible.

Palavras-chave

neoplasias cutâneas - carcinoma basocelular - procedimentos cirúrgicos reconstrutivos

Keywords

skin neoplasm - carcinoma basal cell - reconstructive surgical procedures

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