Brown tumor, although rare, should be listed in the differential diagnosis of expansive mass lesions in the area of the sphenoid sinus and cranial base. The management is multidisciplinary, and therapeutic options should target the underlying cause.

A 33-year-old woman presented with a 3-year history of progressive numbness in the hand, cerebellar ataxia, limb weakness, nystagmus, and dysarthria. T2-weighted MRI revealed abnormal foci of increased signal intensity mimicking demyelinating plaques in the periventricular white matter, and brain 18FDG-PET scan showed increased uptake in the pons. Biopsy from a tibial lesion showed aggregates of foamy histiocytes in the intertrabecular spaces replacing the bone marrow, characteristic of Erdheim-Chester disease. The patient was treated with craniospinal radiation. After 6 months, the clinical picture was stable and the MRI was unchanged.

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Two patients with extra-axial cavernous hemangioma who presented with headache and oculovisual disturbances were investigated with computed tomography and magnetic resonance imaging. The lesions masqueraded as basal meningioma, but this diagnosis was not supported by magnetic resonance spectroscopy in one patient. Cerebral angiography with embolization was indicated in one patient, but embolization was not justified in the other. Both patients underwent a pterional craniotomy. The lesions were extradural and highly vascular, necessitating excessive transfusion in one patient in whom gross total resection was achieved, and precluding satisfactory removal in the other. There was no mortality. Transient ophthalmoplegia, the only complication in one patient, was due to surgical manipulation of the cavernous sinus; it resolved progressively over 3 months. Extra-axial skull base cavernous hemangiomas are distinct entities with clinical and radiological characteristics that differ from those of intraparenchymal cavernous malformations. They can mimic meningiomas or pituitary tumors. In some cases, magnetic resonance spectroscopy may narrow the differential diagnoses. Surgical resection remains the treatment of choice, facilitated by preoperative embolization to reduce intraoperative bleeding and by the application of the principles of skull base surgery. Fractionated radiotherapy is an alternative in partial or difficult resections and in high-risk and elderly patients.

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A 6-year-old Saudi boy was noticed by his family to have a swelling on the left side of his face for 4 months prior to presenting at the hospital. A history of trauma was denied. The lesion was occasionally painful but not cumbersome. The child was admitted to the referring hospital where he underwent temporal craniotomy and attempted excision of the tumor. Physical examination on admission to this Institution revealed a hard swelling at the temporal region in front of the left ear. The lesion was not tender and the overlying skin was normal. No bruit could be heard on or surrounding the swelling. The facial nerve and all other neurological functions were intact. A plain X ray of the skull showed the site of the previous craniotomy. A destructive lesion was shown extending medially to the foramen ovale, posteriorly to the mastoid process, and anteriorly to the sphenoid wing of the temporal bone. Computed tomographic (CT) scan scanning showed a rounded bony lesion arising from the middle cranial fossa. The lesion extended mainly intracranially, compressing the temporal lobe and distorting and expanding the posterior part of the zygomatic process (Fig. 1). Fine trabiculae were seen within the lesion. The posterior part of the lesion enhanced intensely after contrast injection. Multiple fluid-fluid levels were seen. Magnetic resonance imaging (MRI) showed low signal intensity lesion on Tiweighted imaging extending into the base of the left temporal fossa and elevating the left temporal lobe ( Fig. 2). The lesion extended into but did not involve the left temporo-mandibular joint. On T2-weighted imaging, the lesion showed areas of increased signal intensity consistent with subacute bleed; the lesion was loculated and contained multiple fluid-fluid levels.