Technical Strategies for En Bloc Resection and Immediate Reconstruction in Hemangioma of the Frontal Bone

Abstract

Hemangioma of the skull is a benign solitary tumor, often found in the frontal or parietal area. A hemangioma lesion typically involves the outer table rather than the inner, but its complete removal at the diploe level is difficult. Full-thickness resection at the calvaria is often needed to ensure a free margin, but it will leave a bony defect that requires reconstruction. Although curettage and covering of the lesion with alloplastic material are a simple treatment option for hemangioma of the skull, it does not always prevent recurrence. Hence, complete resection is needed. As our technical strategies for reconstruction, we organize a split calvarial bone graft if a defect is near the frontal sinus and calcium phosphate cement if it is somewhat far from the sinus.

Reconstruction of frontal defects with calvarial grafts

“…Following resection, reconstruction was performed with the outer table of split calvarial bone, harvested from the frontoparietal area. The postoperative course was uneventful, without any recurrence at 2-month follow-up (22) . Lubbers et al without any need for a secondary operation (23) .…”

Surgical Management of a Massive Frontal Bone Hemangioma: Case Report

“…1,2,4,[6][7][8][9][10][11]13,15,16,19,20,25,28,33,34 Intracranial extension of a calvarial based intraosseous hemangioma is an infrequent occurrence. [1][2][3]5,13,14,19,20 Few prior reports have noted expansion of these lesions beyond the dural plane. 2,8,11,13,24 Park et al and Khanam et al describe patients with intracranial expansion loosely attached to the dura, while Peterson et al describe a patient with extension through the dura and anastomoses with the thin-walled vessels on the surface of the cerebellum.…”

“…The treatment of choice is en bloc resection with 5 to 10 mm wide bone margin for the primary goals of limiting painful progression, improving cosmesis, and avoiding potential complications such as hemorrhage. 1 2 4 5 7 8 9 11 12 13 14 17 19 20 25 34 35 Utilization of preoperative embolization can be considered to aid surgical resection by decreasing intraoperative blood loss. 7 10 20 25…”

“…1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 These lesions represent 0.2% of primary cranial bone tumors and predominantly present as solitary lesions in the frontal or parietal bone. 1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 They often involve the outer table and diploic space, while sparing the inner table, and are treated with en bloc surgical resection and cranioplasty. 2 13 14 20 Few reports have described intraosseous cavernous hemangiomas extending beyond the inner table or with substantial involvement of the bifrontal calvarium.…”

Morphology of the Aging Forehead: A Three-Dimensional Computed Tomographic Study

“…Unlike the middle and lower face, this upper portion lacks distinct features that constitutes the face and has a geometrically simple curvature, which is a reflection of the underlying frontal bone. Defects in the frontal bone are usually responsible for unsatisfactory cosmesis in the forehead, and the need for and method of reconstruction depends on the type and extent of bony defect [ 1 2 ].…”