Skull-base metastases

Abstract

Metastasis to the skull-base particularly affects patients with carcinoma of the breast and prostate. Clinically, the key feature is progressive ipsilateral involvement of cranial nerves. Five syndromes have been described according to the metastatic site including the orbital, parasellar, middle-fossa, jugular foramen and occipital condyle syndromes. Magnetic resonance imaging (MRI) is nowadays the most useful examination to establish the diagnosis but plain films, CT scans with bone windows and isotope bone scans remain helpful to demonstrate bone erosion. Normal imaging studies do not exclude the diagnosis. The treatment depends on the nature of the underlying tumor. Radiotherapy is generally the standard treatment, while some patients with chemosensitive or hormonosensitive lesions benefit from chemotherapy or hormonotherapy and selected patients from surgical removal. Gamma Knife radiosurgery is sometimes a useful alternative, particularly for previously irradiated skull-base regions, and for small tumors (diameter < 30 mm). The overall prognosis is poor, with an overall median survival of about 2.5 years, probably because skull-base metastases appear late in the course of the disease.

Cavernous Sinus Metastasis of Non-Small Cell Lung Cancer

“…The diagnosis of metastasis to cavernous sinus may be difficult if radiologic finding is lacking 10,11 . Recently, MRI has become the most useful diagnostic tool when evaluating a suspected cavernous sinus neoplasm 12,13 . However, in suspected cases, repetition of imaging studies may be necessary because symptoms and signs can precede detectable changes of the cavernous sinus on diagnostic imaging 10,13,14 .…”

“…Recently, MRI has become the most useful diagnostic tool when evaluating a suspected cavernous sinus neoplasm 12,13 . However, in suspected cases, repetition of imaging studies may be necessary because symptoms and signs can precede detectable changes of the cavernous sinus on diagnostic imaging 10,13,14 . The necessity of biopsy is unclear, especially in patients with known systemic cancer with image-confirmed cavernous sinus lesions 15 .…”

“…The management of cavernous sinus metastasis is palliative 5,15 . Generally, radiation therapy is performed as standard treatment and often leads to improvement of symptoms and alleviation of pain 13 . However, the prognosis is very poor and the median survival is reported to be 4∼4.5 months from the onset of symptoms 3,5 .…”

Jugular Foramen Syndrome as Initial Presentation of Metastatic Lung Cancer

“…Prostate cancer is known to metastasize to bone, particularly the vertebral bodies, pelvic bones, femurs, and ribs. 12 Less commonly, it metastasizes to the cranial base, causing a variety of jugular foramen or cranial nerve dysfunction syndromes. Generally, this occurs in the face of metastatic prostate involvement of the axial skeleton, but there are rare reports of this cranial nerve dysfunction leading to the initial diagnosis of metastatic prostate cancer…”

The diagnosis and management of parasellar tumours of the pituitary

“…Radiosurgery is sometimes a useful alternative, particularly for previously irradiated regions, and for smaller lesions (diameter !30 mm). The overall prognosis is poor, with a median survival of less than 2 years (Laigle-Donadey et al 2005).…”