Staged surgical treatment for a giant hypervascular extra-intracranial metastasis of thyroid cancer using preoperative embolization and total microsurgical removal

• Published in: Interdisciplinary neurosurgery : Advanced techniques and case management 2022-03, Vol.27, p.101387, Article 101387
• Main Authors: Sirko, Andrii, Shponka, Ihor, Hrytsenko, Petro, Halkin, Mykyta, Deineko, Illia
• Format: Article
• Language: English
• Subjects: Hypervascular skull metastases; Papillary thyroid cancer skull metastases; Preoperative embolization
• ISSN: 2214-7519; 2214-7519
• DOI: 10.1016/j.inat.2021.101387

Herein, we present a clinical case of a successfully staged treatment for a patient with giant hypervascular extra-intracranial metastasis of locally advanced stage IVa T3bN1aM1 (skull) papillary thyroid cancer. To treat the patient, we used tactics that included preoperative endovascular embolization and total microsurgical metastasis removal with simultaneous cranioplasty using an individual stereolithographic titanium three-dimensional implant, followed by total thyroidectomy, radiotherapy, and pharmacotherapy (131I radioiodine and suppressive therapies). The patient was diagnosed with papillary cancer after total skull metastasis removal and obtaining path histological and immunohistochemical biopsy material analysis results. Giant hypervascular mass removal is associated with a high risk of intraoperative massive bleeding, unpredictable course of surgical intervention, and consequently, high probability of developing adverse postoperative complications. These cases are described in isolated reports, making this article relevant. The study describes a case when correctly planned tactics allowed operating the patient totally, safely, and with minimal blood loss and suggests the examination tactics in cranial hypervascular tumor patients.