Diagnosing the osteoma
Mr. Suttora's story goes back 26 years, when as a much younger man, he noticed a painful lump on his forehead. As the lump grew steadily and became more obvious to others, he sought medical evaluation and ultimately, had the mass removed without difficulty by a cosmetic surgeon. The diagnosis of a benign osteoma was good news, and surgical removal is usually curative. However, in 2016, Mr. Suttora began to have headaches and pain again. In less than a year, a mass had grown back to about the size of a golf ball.
He was referred to a neurosurgeon, Robert Kerr, MD, PhD, chief of neurosurgery at Huntington Hospital, who has extensive experience in skull-base and brain tumor surgery. Dr. Kerr is the first on Long Island to employ the single-stage custom cranial implant surgery.
"In this situation, we were concerned that we were dealing with a more malignant pathology because the tumor was painful and had grown so rapidly," said Dr. Kerr. The objective of surgery had to be complete removal of the mass that was expanding both outward, under the scalp, and inward, compressing the brain.
Dr. Kerr went on to explain, "Traditionally, to treat an osteoma (or other skull lesion), a two-stage approach was required. The first stage was to perform a craniectomy to completely excise a skull-infiltrating tumor with clear (disease-free) margins. Following surgery, a high-quality computed tomography (CT) scan would be performed and 3D computer modeling used to generate a custom prosthetic. Once the patient had healed from surgery, the patient would return to the operating room for a second procedure to implant the cranial prosthetic."