- Department of Neurosurgery, Maharaja Agrasen Medical College, Hisar, Haryana, India.
- Department of Neurosurgery, Shalby Multi-Specialty Hospital, Ahmedabad, Gujarat, India.
- Department of Anaesthesia Maharaja Agrasen Medical College, Hisar, Haryana, India.
- Department of Pathology, Maharaja Agrasen Medical College, Hisar, Haryana, India.
DOI:10.25259/SNI_63_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Ishu Bishnoi1, Tushit Mewada2, Satish Kumar Bansal1, Geetika Duggal3, Karandeep Singh4. Extensive titanium mesh invasive cranial fibrous dysplasia. 21-Jun-2021;12:299
How to cite this URL: Ishu Bishnoi1, Tushit Mewada2, Satish Kumar Bansal1, Geetika Duggal3, Karandeep Singh4. Extensive titanium mesh invasive cranial fibrous dysplasia. 21-Jun-2021;12:299. Available from: https://surgicalneurologyint.com/surgicalint-articles/10899/
Background: Craniofacial fibrous dysplasia (FD) is a benign lesion. It presents as bony swelling. Even after complete excision, it has a tendency to recur due to some residual lesion in normal bone. Recurrence at same site is common, but it recurs in bone. We are reporting a rare case of recurrent FD engulfing titanium mesh.
Case Description: A 22-year-old girl, who underwent frontal FD excision and reconstruction using titanium mesh surgery 2 years back, came with complaint of progressive bony swelling at same site for 1 year. CT head confirmed bony lesion involving mesh, frontal air sinus. She underwent complete excision of lesion and cranioplasty using bony cement. Biopsy confirmed recurrence of FD and invasion of titanium mesh.
Conclusion: Recurrence of FD, involving cranioplasty titanium mesh, is extremely rare. It suggests local invasiveness of lesion. Recurrence can be prevented by excision of lesion with free bony margins.
Keywords: Craniofacial, Fibrous dysplasia, Titanium mesh
Skull fibrous dysplasia (FD) is a rare, slow-growing tumor, which mostly arises from frontal region.[
A 23 years girl came with complaint of progressively painful swelling over forehead, 2 years ago. CT head confirmed FD of frontal bone and sinuses [
Bicoronal incision was given. The subcutaneous tissue was adhered to bony growth. It was sharply dissected free. The titanium mesh was completely engulfed by recurrent lesion [
Follow-up after 3 months showed satisfactory result. Our plan is to repeat CT head after 1 year.
Craniofacial FD presents with cosmetic disfigurement, pain, vision loss, hearing impairment, and incidentally. It is an uncommon benign lesion, difficult to manage, when involves craniofacial region.[
CT head with 3D reconstruction is investigation of choice.[
Wu et al. reported a case of recurrent craniofacial FD engulfing titanium mesh.[
The surgical management varies according to patient.[
There is no recommendation for reconstruction of bone after second recurrence. We chose bone cement instead of mesh to provide handmade cover for radically excised bone. Long-term result is awaited to confirm our treatment choice.
At present, no medical therapy has been found to be effective. However, it is important that any underlying endocrine abnormalities be treated before surgical intervention.[
Despite its benign nature, craniofacial FD has a tendency to recur after surgery. Frontal FD recurrence occurs due to missed lesion at deeper or difficult locations, for example, in sinus area. Recurrent lesion, with engulfed mesh, is extremely rare and difficult to excise. For best outcome, radical excision with free bony margins must be done.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
We would like to express special thanks to staff Sushila, technician Ramesh Sharma for assisting surgery.
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