Craniofacial reconstruction of primary osteogenic sarcoma of the skull

Background: Osteosarcoma of the skull is an extremely rare tumour. Because it has few symptoms initially, it usually presents after signs and symptoms of local invasion are present. Obtaining negative surgical margins is one of few modifiable survival factors. Resection of these invasive tumours is often limited by the ability to perform a reconstruction that is adequate in form and function. Despite this critical limitation, there are no articles describing reconstructive techniques used after resection of osteosarcoma of the skull. The purpose of this article is, therefore, to describe the reconstructive methods that can be used in the treatment of osteosarcoma of the skull. Methods: A retrospective chart, photographic and radiological study was conducted of cases performed between 1986 and 2007. Tumour characteristics and reconstructive methods were compiled. Results: Six patients were operated for osteosarcoma of the skull. The mean age at surgery was 27 years. Resection margins were positive in three cases. Bony reconstructive methods were split calvarial bone, iliac bone grafts and bone cement. Dural repair was made with a variety of materials. Complex deficits were repaired with rotation and free flaps. Conclusion: This article presents reconstructive methods used for reconstruction of skull defects left after resection of osteosarcoma of the skull. A variety of methods are available to repair complex deficits. Obtaining negative surgical margins is critical for survival. The ability to completely resect an invasive tumour is often limited by advances in reconstructive methods. Thus, progress in craniofacial reconstruction techniques warrant further investigations.