Cryosurgical Cranioplasty Using Autologous Bone for Metastatic Skull Lesion from Hepatocellular Carcinoma - Illustrative Case

Sep 29, 2026

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Cryosurgical cranioplasty using tumor-sterilized autologous bone is presented through an illustrative neurosurgical case involving a 50s man with hepatitis B virus–associated hepatocellular carcinoma. Imaging showed a 5-cm left temporo-parieto-occipital skull lesion with intracranial extension. After excision, the tumor-infiltrated bone flap was treated with liquid nitrogen at −60°C to −80°C for 20 minutes and reimplanted following tumor resection. Follow-up MRI/CT at three months showed no recurrence, excellent flap integration, resolved neurological symptoms, and no imaging artifacts.

LanguageEnglish

CategoryHealthcare

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Case Lessons

Illustrative case

Background

Observations

Lessons

Clinical context and rationale

JOURNAL OF NEUROSURGERY: Case Lessons J Neurosurg Case Lessons 11(1): CASE25852, 2026 DOI: 10.3171/CASE25852 Cryosurgical cranioplasty using autologous bone for metastatic skull lesion from hepatocellular carcinoma: illustrative case Chan-Wei Liu, MD,1 ,2 Tsung-Hsi Tu, MD, PhD,1 ,2 Jau-Ching Wu, MD, PhD,1–3 Wen-Cheng Huang, MD, PhD,1 ,2 and Chao-Hung Kuo, MD, PhD1 ,2 ,4 ,5 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei; 2School of Medicine, National Yang Ming Chiao Tung University, Taipei; 3Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei; 4Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei; and 5PhD Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, New Taipei City, Taiwan BACKGROUND Skull metastases from hepatocellular carcinoma (HCC) are rare and may cause significant neurological deficits. Conventional cranioplasty using titanium mesh or polyetheretherketone can result in imaging artifacts and implant-related complications. Cryotherapy provides a potential means to sterilize tumor-infiltrated autologous bone for reuse in reconstruction. OBSERVATIONS A man in his 50s with hepatitis B virus–associated HCC presented with cognitive and speech disturbances. Imaging revealed a 5-cm left temporo-parieto-occipital skull lesion with intracranial extension. The tumor-infiltrated bone flap was excised, treated with liquid nitrogen at −60°C to −80°C for 20 minutes, and reimplanted after tumor resection. Histopathology confirmed metastatic HCC involving the skull and brain. Three-month follow-up MRI and CT demonstrated no recurrence, excellent bone flap integration, and no imaging artifacts. The patient’s neurological symptoms were resolved postoperatively. LESSONS Cryosurgical cranioplasty using autologous bone offers a biologically compatible, imaging-friendly, and oncologically safe alternative to synthetic implants for metastatic skull lesions, enabling effective reconstruction and reliable postoperative surveillance. [https://thejns.org/doi/abs/10.3171/CASE25852](https://thejns.org/doi/abs/10.3171/CASE25852) KEYWORDS cryosurgery; cranioplasty; autologous bone graft; skull metastasis; bone reconstruction; neuro-oncology Skull metastases can attain considerable size, potentially compressing dural venous sinuses or cranial nerves and leading to significant neurological morbidity.1 Given the risk of progressive neurological deterioration and skeleton-related events, prompt and effective local control is essential. Current therapeutic strategies include resection with subsequent cranioplasty or reconstruction, adjuvant radiotherapy, and systemic treatments, such as hormonal, chemotherapeutic, or immunotherapeutic therapy, tailored to the primary tumor type and disease extent. Cranioplasty is a reconstructive procedure performed to restore the structural integrity and contour of the skull following tumor resection or craniectomy. Among alloplastic materials, titanium mesh (TiMesh) and polyetheretherketone (PEEK) are the most commonly used options. Both provide excellent mechanical strength and biocompatibility, although they differ in material properties, complication profiles, and cost.2 TiMesh is favored for its rigidity, durability, and costeffectiveness. It is associated with shorter hospital stays and lower rates of postoperative hematoma or fitting inaccuracy compared with nontitanium materials.3,4 However, TiMesh carries a higher risk of implant exposure and postoperative discomfort, which may not always necessitate secondary surgery.4,5 TiMesh is also prone to cold sensitivity and may cause imaging artifacts due to its metallic composition.6 PEEK, a high-performance polymer with mechanical properties closely resembling native bone, offers excellent biocompatibility and is nonferromagnetic, allow

FAQs

Why was cryosurgical treatment considered for the metastatic skull lesion?

Conventional cranioplasty materials can cause imaging artifacts and implant-related complications. Cryotherapy offers a way to sterilize tumor-infiltrated autologous bone for reuse in reconstruction.

How was the autologous bone flap processed before reimplantation?

After excision, the bone flap was treated with liquid nitrogen at −60°C to −80°C for 20 minutes and reimplanted after tumor resection.

What were the main postoperative outcomes observed during follow-up?

Three-month MRI and CT showed no recurrence, excellent bone flap integration, and no imaging artifacts, and the patient’s neurological symptoms resolved after surgery.

Sep 29, 2026

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