|Mitsuya K, Nakasu Y|
Metastatic Skull Tumours: Diagnosis and Management
European Association of NeuroOncology Magazine 2014; 4 (2): 71-74
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Keywords: base of the skull, calvarium, cranial nerves, metastatic cancer, occipital condyle syndrome, radiation therapy
Metastases of the skull are classified into 2 anatomical groups, presenting distinct clinical features. One is calvarial metastasis, which is usually asymptomatic but may cause dural invasion, dural sinus occlusion, or cosmetic problems. The other is skull-base metastasis, which presents with cranial-nerve involvement leading to devastating symptoms. A high index of suspicion based on new-onset cranial nerve deficits or craniofacial pain in a cancer patient is important for early diagnosis and prompt management. Magnetic resonance imaging is the primary diagnostic tool. Skull metastasis is a focal lesion with a low-intensity signal on T1-weighted images. Enhanced T1-weighted images with fat-suppression show tumour, dural infiltration, and cranial nerve involvements. Irradiation is the effective and firstline therapy for most skull metastases. Chemotherapy or hormonal therapy is applied depending on tumour sensitivity. Bone resorption inhibitory drugs are used as a part of systemic therapy, and are to be studied for prevention of symptomatic skull metastasis. Surgery is indicated in selected patients with good performance status who need immediate decompression, cosmetic recovery, or histological diagnosis.