Tokushukai Medical Group

Treatment of disorder

medical treatment

Cranial Nerve Surgery Disease:Malignant Bone Tumor

Osteogenic Sarcoma – The most common malignant tumor in bone primary tumor.

Osteosarcoma is the most common malignant tumor in bone primary tumor, and is mainly developed in long-bone. It is reported that the development at cranial bone is extremely rare case, less than 2%. This is common in male, and displaced at early stage to lung, then complicated with respiratory failure to die. 5 years survival rate is said less than 20%.

We have two self-test examples, the one is 32 years old male, appeared at parietal region, the other is 30 years male, appeared at orbital region. The former parietal region pathological change case was that he rejected a repetition of chemotherapy in the mid-course so that repeated the recurrence and died in 12 years course period. The other is that no sign of recurrence can be seen in 35 years prognosis. Radiation therapy after the surgery and repeated chemotherapy with primary CDDP make this possible.

Pathological change indicating heterogenous enhancement (augmentative effect) is recognized by bone destructive contrast at CT/MRI. Treatment of total removal and radiation chemotherapy after surgery are recommended.

Chordoma – displacement widely on medulla spinal cord surface.

Chordoma is a tumor originated out of the remaining of notochord of vertebrate animals and is the cancerized thing which chorda dorsalis is left when chorda dorsalis transformed into spinal cord. Therefore, it is originated along the body center lines. Bone originated sarcomas are in order of bone sarcoma, chondrosarcoma, Ewing's sarcoma, chordoma, and 30% of them are bone sarcoma and chordoma is a quite rare case. They are less than1% of entire tumor case, but it is difficult to differentiate from chondrosarcoma, and it has an characteristics of displacing broadly to the cerebrospinal surface. It is said that they are easy to be developed at the diagonal of the skull and vertebral vertebrae of the spine. That is, it is reported that 50% of them are developed at sacral region, 35% are at skull base, and 15% are at spine.

Tumor resides epidurally, but it progresses intradural as well. Existence or non-existence of bone change or calcification are observed by CT. MRI observes progressed area of tumor, but it is difficult to promptly identify displacement area with the reason of tumor infiltration is high.

Complete removal is important in the treatment, but it is easy to recur, and all that is left is radiation therapy. Occasionally, there is a case where heavy particle beam or proton beam therapy are expected. Depend on the part or progress degree of left-right, and with considering the invasiveness by the traditional craniotomy, nasal endoscopic surgery is well advanced recently, invasiveness is low enough, and removal ratio is getting high so that there increases the case in selecting this surgical method. Finally, it is important to try complete removal on the base of enough plan, like learning level of the operator’s skill.

Giant Cell Tumor – the development on cranial bone is extremely rare case.

Osteosarcoma, Chondrosarcoma, Ewing’s sarcoma, and Giant cell tumor of bone can be listed as sarcoma developed on the field of orthopedics, but giant cell tumor developed on skull is a very rare case.

Their classification is in benign bone tumor, but comparing with other benign bone tumor, giant cell tumor is easy to reappear and having characteristics of causing lung displacement so that WHO recognizes it as intermediate malignant tumors. Local reappearance rate is high, but it is a benign tumor so that life prognosis is in goodness. It is said that even though lung displacement occurred, there is no problem in the prognosis. Finally, in 96% to 100% of the case, local control is gained.

To diagnose, image examination like CT, MRI, bone scintigraphy, and PET are necessary. Finally, it is necessary to conduct the biopsy to reach diagnosis, but for skull cases, complete removal should be set out, if possible. After the surgical treatment, human-type monoclonal antibody formulations, treatment of molecular marker which target the rankle so called denosumab, and molecular target treatment. Are used. Giant cell tumor of bone consists with 2 kinds of cells, such as interstitial cell and giant cell, and this interstitial cell produces the rankle, activates the giant cells, and destroys the bones. It is used as new type hypodermic drug that denosumab is combined with the material named as rankle to hold giant cell tumor from getting larger. Sie effects are jaw osteonecrosis and hypocalcemia.

Osteochondroma – benign tumor commonly found in childhood.

Osteochondroma, among the primary bone tumor, is the most common benign tumor. It develops on diaphysis end of long tubular bone, and many of them are found in childhood. Bone is extracted out like swelling from bone surface is called as external hematoma, extracted inside is called as internal hematoma. The one come to an issue at cerebral surgery is the latter one, and its surface is covered with cartilage histology. Coming from the entire shape, it is called external hematoma. It is very rare case where it is developed in the skull. There may be a case where this tumor malignantly changed into chondrosarcoma.

Chondrosarcoma – 2nd common in primary malignant bone tumor

Chondrosarcoma is a second-high frequent primary malignant bone tumor after bone cancer and develops commonly amongst the middle-aged people over 40s. It may be developed secondarily from benign bone tumor like osteochondroma or enchondroma. Normally it is developed on thighbone or upper forelimb bone at proximal limb, pelvis or costal bone. It is extremely rare case where it is developed in the skull. With comparing to child, it is hardly displaced and grows relatively slowly.

To diagnose, CT, MRI and bone scintigraphy are useful. In bone scintigraphy, positive is appeared but it brings out teeth at the diagnosis of displacement.

Surgery is the base of the treatment. Operational surgery is requested since radiation or chemotherapy are hard to work out. Heavy particle beam or proton beam therapy are expected. Complete removal is the base for lung displacement.