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Chapter 13: Surgical Treatment of Skull Tumors 125

A

B D

C

Figure 13.9 (A) Sagittal and transverse images of the skull mass preoperatively. (B) Skull mass after resection with CUSA. (C) Removal of the skull mass.
(D) Skull defect after mass removal. (Note that the frontal sinuses have been flushed with Betadyne solution prior to the resection and the entrance into the
nasal cavity has been packed with gelatin sponges and bone wax.)

prior to reconstruction. If desired, Vetrix® BioSIS ECM (Vetrix Inc., Some of the extremely large skull masses require extensive resec-
Cumming, GA) can be placed over the exposed brain to decrease tion and reconstruction, which can be performed with creation of a
the risk of adhesions. Closure will vary depending on the size and polymethylmethacrylate (PMMA) prosthesis or titanium mesh
location of the resultant defect. In many cases the preserved tempo- [20,21]. Advantages of this reconstruction method include
ralis fascia can be used to cover the defect with closure of the sub- improved cosmesis and increased protection of the exposed brain
cutaneous and skin in routine fashion. from accidental trauma. The main disadvantages include cost,