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. 2017 Mar 7;9(3):e1083.
doi: 10.7759/cureus.1083.

Scalp Seeding Post Craniotomy and Radiosurgery for Solitary Brain Metastasis: A Case Report and Systematic Review

Waseem Sharieff  1 , Liam Mulroy  2 , Adrienne Weeks  3 , Samina Mansoor  4 , Rajbir Pahil  5 , Muhammad U Islam  6
Affiliations

Scalp Seeding Post Craniotomy and Radiosurgery for Solitary Brain Metastasis: A Case Report and Systematic Review

Waseem Sharieff et al. Cureus. .

Abstract

Background: Radiosurgery is being increasingly used post craniotomy for brain metastasis, instead of whole-brain radiation. We report a case of scalp metastasis following craniotomy and radiosurgery, along with a systematic review of the literature.

Methods: Our patient was a 70-year-old male who presented with a scalp metastasis, two years after craniotomy and radiosurgery, for a solitary brain metastasis from esophageal carcinoma. Using Medline® (United States National Library of Medicine, Bethesda, MD), we performed a systematic review of the literature to identify cases of isolated scalp metastases following craniotomy for brain lesions.

Results: The scalp metastasis was in close proximity to the craniotomy site. Workup did not show any other site of active disease. Biopsy confirmed it to be a metastasis from esophageal carcinoma. The literature review did not yield any case of isolated scalp metastasis following craniotomy and whole-brain radiotherapy or radiosurgery. However, it yielded six cases of isolated scalp metastases following craniotomy for primary brain tumors.

Conclusion: Isolated scalp metastasis has not been reported following craniotomy and whole-brain radiotherapy for brain metastases. Our patient likely had surgical seeding during craniotomy. These surgically implanted cells could not be ablated because the radiosurgery treatment volume does not cover the surgical tract. Further research is needed to identify risk factors for surgical seeding.

Keywords: brain metastases; craniotomy; radiosurgery; scalp metastases.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Radiosurgery Plan
CT images showing planning target volume (PTV) and radiation isodose levels in axial (A), coronal (C) and sagittal (D) planes. Dose volume histogram showing adequate coverage of PTV while maximal sparing of the brain stem, chiasm, and lenses (B).
Figure 2
Figure 2. Scalp Metastasis Post Craniotomy and Radiosurgery
A-D: Gadolinium enhanced T1 MRI sequences. A solitary metastatic lesion in the left parietal lobe is evident in A. B shows post-surgical changes following craniotomy. Enhancement in the surgical cavity is seen (C), and a new lesion in the left parietal bone is noted (D). E-F: MR perfusion images showing no blood flow in the surgical cavity (E), and increased blood flow in the region of scalp metastasis (F).
Figure 3
Figure 3. Scalp Metastasis From Esophageal Carcinoma
A: Higher magnification of the primary tumor shows features of adenocarcinoma - glandular crowding, cribriforming, cytologic atypia, loss of polarity and increased mitotic activity. B: Higher magnification of scalp lesion shows similar features. C and D: Immunohistochemistry shows positive staining of cells to CDX2 and CK7, respectively.
Figure 4
Figure 4. Scalp Metastasis
A-B: Axial CT images showing scalp site of metastasis before (A) and after radiotherapy (B). Note the craniotomy defect.
See this image and copyright information in PMC

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