Multidisciplinary team spirit:

A dedicated team of doctors from Aarhus University Hospital saves a 67 year old international patient from a rare form of cancer on the scalp.

On 11 August 2013 she set foot on Danish ground for the first time. On 15 August she underwent a 13-hour long operation for a rare type of cancer on her scalp. Today – two months later - she is doing fine, has just returned home and is looking forward to resume her work.

The 67-year-old international patient has had a rather turbulent and long course of disease. In 1983, she felt a small lump behind her ear. It turned out that it was a benign tumor - a socalled Schwannoma - emanating from the cells protecting the nerve cells which are also found on the scalp.

Treatment at home and abroad
In her home country, it was attempted to remove the benign lump several times. However, Schwannomas are very hard to cure. In 2010, the lump changed and turned malignant and the patient chose to travel to Georgetown University Hospital in the USA to have it removed.

Here it was attempted to surgically remove the tumour several times and treat it with radiotherapy - as late as in spring 2013.

Dangerous operation
Then the woman got in contact with Aarhus University Hospital. At this point, the cancer tumour had grown and spread to the membrane of the brain - the protective layer surrounding the brain. It was therefore quite dangerous to perform further surgery on this patient who had already undergone several surgeries.

Biological mesh on the brain
A highly specialised team at Aarhus University Hospital consisting of neurosurgeons, plastic surgeons, oncologists, radiologists and microbiologists believed it was safe to perform another operation on the patient. The woman arrived in Aarhus where the multidisciplinary team performed the operation on August 15, 2013:

Neurosurgeons made an incision and removed the malignant tumour and part of the dura, the membrane protecting the brain. A plastic surgeon constructed a cellular dermal matrix, a so called biological mesh in order to reconstruct the removed dura. Then the plastic surgeons reconstructed the bony defect on the scalp using a muscle from the patient's back and blood supply was established through blood vessels from the patient's back of head and neck.
Finally, a horseshoe-shaped frame was placed on the patient's head - a so called halo-frame - to protect the patch and assist it in integrating into the remaining skin on the patient's scalp.

The patient with the halo-frame (photo: Tonny Foghmar, Aarhus University Hospital).

Blood supply to flaps is crucial
According to the plastic surgeons at Aarhus University Hospital, it is the first time in Denmark – and maybe in Europe – that this specific biological mesh has been used for this purpose.
The biological mesh is already used in reconstruction of the abdominal wall as well as for reconstructive plastic surgery of the breast. The crucial factor for the success of the international patient's surgery was to ensure that blood supply could be established so the brain could be protected by living tissue.

Thanks to the team
The defect of the scalp of the international patient was successfully reconstructed. Today, two months after the surgery, she is fine. She just returned to her home country and is looking forward to resume her work.

The very malignant cancer cells are gone. But the patient knows there is no guarantee that the cancer will not come back. She is very grateful to the team at Aarhus University Hospital and she feels her life has been saved.