title: Double concentric craniotomy: Safe and effective technique to achieve an en bloc resection of tumor involving both skull and duraa.
abstract: BACKGROUND
  Many tumors can involve the skull. Meningiomas are one of the most common intracranial neoplasms and invasion of the bone was described in 49% of cases. Other neoplastic lesions that can arise in bone, or involve it, are metastases, hemangiomas, aggressive cutis carcinomas and sarcomas. Radical excision is the golden standard of treatment but elevating a bone flap when the tumor involves both the skull and the dura could represent a technical challenge.
  
  
  METHODS
  We report the technical details of our approach to remove a meningioma involving both skull and dura in a man aged 45. Patient underwent gross total excision and cranioplasty with PEEK custom made prothesis (Synthes™).
  
  
  CONCLUSIONS
  We describe a double concentric craniotomy (DCC) technique where the tumor involving the bone is before left in situ, exposing normal dura, to perform afterwards en-bloc excision with minimal traction of brain surface.
  
  
  CONCLUSIONS
  DCC is a safe and effective technique to remove tumor involving both skull and dural structures under direct vision.
authors.affiliation: University of Torino, Dept. Of Neuroscience, Institute of Neurosurgery, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Fornaro
authors.affiliation: University of Torino, Dept. Of Neuroscience, Institute of Neurosurgery, Italy. Electronic address: roberto.altieri.87@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Altieri
authors.affiliation: University of Torino, Dept. Of Neuroscience, Institute of Neurosurgery, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Garbossa
authors.affiliation: University of Torino, Dept. Of Neuroscience, Institute of Neurosurgery, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Zenga
authors.affiliation: University of Torino, Dept. Of Neuroscience, Institute of Neurosurgery, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Tartara
authors.affiliation: University of Torino, Dept. Of Neuroscience, Institute of Neurosurgery, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ducati
keywords: Brain tumor; Concentric craniotomy; En bloc resection; Skull tumor