Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2015; 34(01): 056-060
DOI: 10.1055/s-0035-1547381
Case Report | Relato de Caso
Thieme Publicações Ltda Rio de Janeiro, Brazil

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

Multiple Scalp Tumors with Intracranial Invasion: Resection and Reconstruction with Myocutaneous Flap of Latissimus Dorsi Muscle
Bernardo Corrêa de Almeida Teixeira
1   Acadêmico da Liga de Neurocirurgia do Hospital Erasto Gaertner, Curitiba, PR, Brasil
,
Johnni Oswaldo Zamponi Junior
1   Acadêmico da Liga de Neurocirurgia do Hospital Erasto Gaertner, Curitiba, PR, Brasil
,
Rodrigo Leite Morais
2   Neurocirurgião do Hospital Erasto Gaertner, Curitiba, PR, Brasil
,
Andrei Leite Morais
2   Neurocirurgião do Hospital Erasto Gaertner, Curitiba, PR, Brasil
,
Alceu Correa
2   Neurocirurgião do Hospital Erasto Gaertner, Curitiba, PR, Brasil
,
Anne Groth
3   Cirurgiã Plástica do Hospital Erasto Gaertner, Curitiba, PR, Brasil
› Author Affiliations
Further Information

Publication History

30 July 2013

01 November 2014

Publication Date:
29 April 2015 (online)

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.

 
  • Referências

  • 1 Wagner RF, Lowitz BB, Cas Ciato DA. Skin cancers. In: Casciato DA, Lowitz BB, (editors). Manual of Clinical Oncology. 2nd ed. Boston: Little, Brown, and Company; 1988: 250-259
  • 2 Baker NJ, Webb AA, Macpherson D. Surgical management of cutaneous squamous cell carcinoma of the head and neck. Br J Oral Maxillofac Surg 2001; 39 (2) 87-90
  • 3 Martin 2nd RC, Edwards MJ, Cawte TG, Sewell CL, McMasters KM. Basosquamous carcinoma: analysis of prognostic factors influencing recurrence. Cancer 2000; 88 (6) 1365-1369
  • 4 Anderson PJ, Ragbir M, Berry RB, McLean NR. Reconstruction of the scalp and cranium using multiple free-tissue transfers following recurrent basal cell carcinoma. J Reconstr Microsurg 2000; 16 (2) 89-93
  • 5 Chang DW, Langstein HN, Gupta A , et al. Reconstructive management of cranial base defects after tumor ablation. Plast Reconstr Surg 2001; 107 (6) 1346-1355
  • 6 Chandrasekhar B, Jose TE. Non melanoma skin cancer. In Robert Mckenna Sr, Gerald P, editors. Cancer Surgery. 2nd ed. Philadelphia: Murphy Lippincott; 1997: 537-550
  • 7 Weber RS, Lippman SM, McNeese MD. Advanced basal and squamous cell carcinomas of the skin of the head and neck. In: Jacobs C, , editor. Carcinomas of the Head and Neck: evaluation and management. Boston: Kluwer Academic; 1990: 61-81
  • 8 Jones NF. Resection and reconstruction of extensive and complex tumors of the head and neck. In: Soutar DS, Tiwari R, , editors. Excision and reconstruction in head and neck cancer. Edinburgh: Churchill Livingstone; 1994: 405
  • 9 Schroeder M, Kestlmeier R, Schlegel J, Trappe AE. Extensive cerebral invasion of a basal cell carcinoma of the scalp. Eur J Surg Oncol 2001; 27 (5) 510-511
  • 10 Parizel PM, Dirix L, Van den Weyngaert D , et al. Deep cerebral invasion by basal cell carcinoma of the scalp. Neuroradiology 1996; 38 (6) 575-577
  • 11 Grekin RC, Schaler RE, Crumley RL. Cancer of the forehead and temple regions. Dermatol Clin 1989; 7 (4) 699-710
  • 12 Barrett TL, Greenway Jr HT, Massullo V, Carlson C. Treatment of basal cell carcinoma and squamous cell carcinoma with perineural invasion. Adv Dermatol 1993; 8: 277-304
  • 13 Orticochea M. Four flap scalp reconstruction technique. Br J Plast Surg 1967; 20 (2) 159-171
  • 14 Wackym PA, Feuerman T, Strasnick B, Calcaterra TC. Reconstruction of massive defects of the scalp, cranium, and dura after resection of scalp neoplasms. Head Neck 1990; 12 (3) 247-253
  • 15 Ioannides C, Fossion E, McGrouther AD. Reconstruction for large defects of the scalp and cranium. J Craniomaxillofac Surg 1999; 27 (3) 145-152