Freiburg Neuropathology Case Conference

Excerpt

A 54-year-old male patient presented with a painless mass lesion of the parietal and occipital bone. He had realized the presence of the lesion about 15 years earlier. The size of the lesion remained relatively stable for a long period of time and started increasing only 3 years ago. Any neurological disorders, particularly headaches, or seizures were denied and the clinical examination was unremarkable. The lesion presented as a painless solid swelling, the overlying skin was intact and relocatable. The patient was operated on in a prone position with the head orthograde in a Mayfield skull clamp. Using a U-shaped incision around the lesion, skin and galea periosteum were dissected from the lesion, both of which were unremarkable. The whole lesion was depicted up to where apparently normal skull bone was visible, which was confirmed by neuronavigation. Using the template of the cranioplasty implant and neuronavigation the lesion was resected in several parts using a craniotome. The resulting bone edges were unremarkable. Adhesions of the lesion to the dura were separated using sharp dissection, the remaining dura looked inconspicuous. Intradural tumor growth was ruled out using intraoperative ultrasound. A PEEK cranioplasty implant (3di, Jena, Germany) was put in place and fixed with titanium platelets. Postoperative care was unremarkable, no neurological deficit occurred, wound healing was normal and the patient was discharged 6 days after the procedure. …