Adjuvant therapy by high-speed burr may cause intraoperative bone tumor seeding: an animal study

The Utility of Bone Burring for the Clearance of Locally Advanced Scalp Malignancies: A Scoping Review

The scalp harbors a range of neoplasms occurring at inordinate rates and associated with poorer outcomes. Its unique anatomy poses surgical challenges, including clear deep margins when resecting these lesions. For malignancies extending to the pericranium, removal of outer cortical cranial bone is ideal and routinely achieved with a burr. This review aims to investigate the literature to ascertain the utility and safety of this technique while highlighting evidence gaps.

Methods

A literature search was conducted systematically using MEDLINE, Embase, and PubMed. Articles were reviewed for inclusion, and eligible studies were analyzed for study design, patient and intervention details, and outcome measures. A formal statistical analysis was not conducted.

Results

The original search yielded 1506 unique results, and eight studies met the inclusion criteria: four case series, two retrospective analysis of records, two case reports. A number of tumor types were identified, but the burring method used was consistent in all studies. Despite reassuring primary outcome measure results, specifically in terms of local control rates, the overall evidence quality is limited by the nature of the included studies. Few adverse events were reported.

Conclusions

Evidence for the oncological efficacy of scalp bone burring remains limited. Although the technique seems relatively safe, further investigation is required into its utility and drawbacks. Future studies should aim to report more technical details and more information about outcomes. It may also be worth comparing burring to alternatives such as outer cortical splitting, curettage, and high-dose curative radiotherapy.

'Triple clear': a systematic and comprehensive surgical process for Campanacci grades II and III giant cell tumors of the bone, with or without pathological fracture and slight joint invasion

BACKGROUND

In recent years, researchers have proposed a number of adjuvant methods for extended curettage of giant cell tumors of the bone. However, various schemes have significant differences in efficacy and safety. Therefore, this article will describe an empirical expanded curettage protocol, 'triple clear', in detail to show the effect of the efficient surgical protocol.

METHOD

Patients with Campanacci grades II and III primary GCTB who were treated with either SR (n = 39) or TC (n = 41) were included. Various perioperative clinical indicators, including the therapy modality, operation time, Campanacci grade, and filling material were recorded and compared. The pain level was determined by the visual analog scale. Limb function was determined by the Musculoskeletal Tumour Society (MSTS) score. Follow-up time, recurrence rates, reoperation rates, and complication rates were also recorded and compared.

RESULT

The operation time was 135.7 ± 38.4 min in the TC group and 174.2 ± 43.0 min in the SR group (P < 0.05). The recurrence rates were 7.3% in the TC group and 8.3% in the SR group (P = 0.37). The MSTS scores at three months after surgery were 19.8 ± 1.5 in the TC group and 18.8 ± 1.3 in the SR group. The MSTS scores at two years were 26.2 ± 1.2 in the TC group and 24.3 ± 1.4 in the SR group (P < 0.05).

CONCLUSION

TC is recommended for patients with Campanacci grade II-III GCTB and for those with a pathological fracture or slight joint invasion. Bone grafts may be more suitable than bone cement in the long term.

Diaphyseal giant cell tumor with multiple relapses in a skeletally immature patient: a case report

Giant cell tumor (GCT) is an aggressive osteolytic lesion mostly affecting the meta-epiphyses of long bones at skeletal maturity. Occurrence of the GCT in diaphysis is a rare entity in adult and exceptionally rare in pediatric population. This is the only third diaphyseal case reported in pediatric population. We report a case of recurrent diaphyseal GCT in a skeletally immature patient of 15-year-old male at the right radius after previous resection with plate and screw fixation. Upon optimal investigations, en-bloc resection of the tumor with radial resection and ulna centralization with wrist arthrodesis was done for a campanacci stage III GCT. The patient had an uneventful recovery without recurrence for 2 years and 2 months following surgery. The main challenge relies on accurate diagnosis due to uncommon location that hinders adequate treatment plan, therefore diagnosis should be solely based on histopathology findings.

Management of the Cavity After Removal of Giant Cell Tumor of the Bone

Purpose: To find out the most appropriate management scheme through the analysis and comparison of different inactivation methods and filling materials. Method: A systematic literature search was performed using the terms, anhydrous ethanol, phenol, hypertonic saline, cryotherapy, thermal therapy, bone reconstruction, GCTB, and etc., Selected articles were studied and summarized. The mechanism, clinical effects, and influence on bone repair of various methods are presented. Recent developments and perspectives are also demonstrated. Recent Findings: Compared to curettage alone, management of the residual cavity can effectively reduce the recurrence of giant cell tumours of bone. It is a complex and multidisciplinary process that includes three steps: local control, cavity filling, and osteogenic induction. In terms of local control, High-speed burring can enlarge the area of curettage but may cause the spread and planting of tumour tissues. Among the inactivation methods, Anhydrous ethanol, and hyperthermia therapy are relatively safe and efficient. The combination of the two may achieve a better inactivation effect. When inactivating the cavity, we need to adjust the approach according to the invasion of the tumour. Filling materials and bone repair should also be considered in management.